DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Tense hematoma of right upper arm with symptoms of compartment syndrome.
2. Status post cardiac catheterization and percutaneous coronary intervention via right upper extremity.
3. Median neuropraxia with diminished motor and sensory function in the right hand.
POSTOPERATIVE DIAGNOSES:
1. Tense hematoma of right upper arm with symptoms of compartment syndrome.
2. Status post cardiac catheterization and percutaneous coronary intervention via right upper extremity.
3. Median neuropraxia with diminished motor and sensory function in the right hand.
OPERATION PERFORMED:
1. Repair of right brachial artery iatrogenic puncture.
2. Evacuation of right upper extremity hematoma.
3. Fasciotomy, right upper arm.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 200 mL.
DRAINS: Jackson-Pratt x1.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female, status post percutaneous coronary intervention via a right brachial approach. She presented this evening with a very painful, tense right upper arm. We went to examine her, and at that time, she had diminished motor and sensory function in the right hand. She had a flexion contracture at the right elbow and could not straighten the arm, and the right upper arm from the elbow to the axilla was tense and tender. The patient was transferred by ambulance and taken immediately to the operating room for evacuation of the hematoma, repair of the artery, and fasciotomy.
DESCRIPTION OF OPERATION: The patient was placed in the supine position on the operating table. Following the induction of general anesthesia, the right upper extremity was abducted and then prepped and draped in the usual sterile fashion. A skin incision was made beginning at the antecubital fossa extending along the medial aspect of the upper arm for approximately 12 cm. Subcutaneous tissues were incised.
The fascia of the biceps was incised and a large, tense hematoma was evacuated. This resulted in recovery of the ability to fully extend the arm at the elbow. Even when anesthetized prior to opening the fascia, the arm would not straighten. Once the hematoma had been evacuated, bleeding was noted to come from the brachial artery, a short distance above the antecubital space. The artery was controlled by digital pressure over the hole.
The artery was then dissected out and surrounded proximally and distally with a vessel loop. Heparin 5000 units was administered intravenously and allowed to circulate for 3 minutes. The vessel loops were then used to occlude the brachial artery and the hole was oversewn with interrupted 6-0 Prolene sutures. The artery was reopened, and there was no further arterial bleeding. The patient was noted to have a palpable radial pulse at the wrist.
Heparin was then reversed with 50 mg of intravenous protamine. Fasciotomy was extended into the proximal forearm and up to a point just below the axilla. All the hematoma that could be evacuated was removed and the arm was then irrigated with copious amounts of saline.
A 10 mm Jackson-Pratt drain was then placed in the arm wound at a subfascial level. It was brought out through a separate inferior stab wound on the volar forearm. It was sutured to the skin at its exit site with 3-0 nylon suture. The fascia and subcutaneous tissues were left open and the skin was then closed with interrupted 3-0 nylon vertical mattress sutures. Instrument, needle, and sponge counts were correct. Sterile dressings were applied, and the patient was awakened and transferred to the recovery room in good condition.
