DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Radial digital nerve injury, right index finger.
POSTOPERATIVE DIAGNOSIS: Radial digital nerve injury, right index finger.
OPERATION PERFORMED:
1. Primary repair of the radial digital nerve, right index finger.
2. Application of short-arm plaster splint.
3. Use of operating microscope.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
TOURNIQUET TIME: 70 minutes.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient is a previously healthy (XX)-year-old right-hand dominant male who was in his usual state of health until last week. The patient sustained a right index finger laceration while working. The patient lacerated the right index finger and was found to have altered sensibility along the radial aspect of the right index finger. The patient presented to the office and was diagnosed with a digital nerve laceration. Risks and benefits of the operation have been discussed with the patient. He now presents for operative exploration and repair.
OPERATIVE FINDINGS: Please see operative procedure.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was given 1 gram of intravenous antibiotics. He was subsequently taken to the operating room and placed in the supine position with the right arm extended. Bilateral sequential compression boots were applied, and the patient was placed under general anesthesia without difficulty. The right upper extremity was prepped and draped in the usual sterile manner. The arm was then elevated, exsanguinated, and the axillary tourniquet was inflated to 250 mmHg.
The right index finger laceration was opened and was extended both proximally and distally in a zig-zag manner to facilitate wound exposure. The skin flaps were dissected with a #15 blade and were held in position with interrupted 4-0 nylon sutures. The subcutaneous tissues were gently dissected and the proximal and distal aspects of the radial digital nerve were identified. There was found to be a 100% transection of this nerve.
At this point, the operating room microscope was brought into the field, and the remaining portion of the operation was performed under the microscope. Proximal and distal nerve ends were identified and were released from all adjacent soft tissue structures. The proximal and distal ends were subsequently transected to create fresh edges for suturing. A primary end-to-end epineurial repair was then performed at the radial digital nerve utilizing interrupted 9-0 nylon suture. At the end of the repair, the nerve was found to be in an excellent approximation. Two small pieces of Gelfoam were then placed around the nerve coaptation site.
The tourniquet was deflated. Bleeding points were controlled with direct pressure and hand elevation. The skin was then closed in one layer with interrupted 5-0 Prolene suture. Antibiotic ointment was then applied to the incision line.
Gauze dressing, cast padding, and a dorsally-based plaster splint were then applied to the hand, maintaining the hand in a slightly flexed position. The patient tolerated the procedure very well and was withdrawn from general anesthesia without complications and transported to the recovery area in good condition. The patient will go home today with prescriptions for both antibiotics and pain medications. He will then follow up with us in the office next week for initial wound evaluation.
