DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Soft tissue mass, right thumb.
POSTOPERATIVE DIAGNOSIS: Soft tissue mass, right thumb.
PROCEDURE PERFORMED: Excision and biopsy of soft tissue mass, right thumb.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
SEDATION: IV sedation plus digital block.
COMPLICATIONS: None.
OPERATIVE FINDINGS: The patient had a 1 cm firm soft tissue mass on the ulnar aspect of the right thumb distal phalanx. Preoperative MRI images showed the mass appeared to be contained within the subcutaneous plane with no evidence of penetration into the tendon sheath, distal phalanx bone or interphalangeal joint.
Exploration revealed a solitary brownish-colored firm soft tissue mass, which appeared to be encapsulated in the subcutaneous plane on the ulnar aspect of the distal phalanx. There was no sign of any penetration into the joint space, tendon sheath or bone surface. The terminal neurovascular structures were adherent to the mass, but the mass did not appear to be arising from these structures.
DESCRIPTION OF PROCEDURE: Informed consent was obtained from the patient’s parents. She was taken to the operating room following preoperative MRI imaging. IV sedation was given by the anesthesiologist. The right hand was prepped and draped sterilely. We administered local anesthetic at the base of the right thumb with digital block using plain lidocaine and plain Marcaine. A digital tourniquet was applied at the base of the right thumb without exsanguinating the digit.
A midlateral incision was made over the ulnar aspect of the distal phalanx centered at the soft tissue mass. Under loupe magnification the subcutaneous tissue was dissected. The mass was identified. Skin flaps were elevated off the mass. The neurovascular structures were dissected free from the mass and retracted safely. The mass was then excised and blocked and sent to pathology as a biopsy specimen. The depth of the wound was explored and no additional pathologic tissue was seen.
The field was irrigated with antibiotic solution. The skin edges were reapproximated with nylon sutures. The digital tourniquet was removed. Circulation returned to the right thumb, hand with normal capillary refill distally. Bleeding was controlled with direct pressure and hemostasis was achieved. A sterile gauze dressing was applied. The patient was transported to the recovery room in stable condition. She tolerated the procedure well, and there were no complications.
