Dupuytren’s Contracture Excision Sample Report
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Dupuytren’s left long finger and palm.
POSTOPERATIVE DIAGNOSIS: Dupuytren’s left long finger and palm.
OPERATION PERFORMED: Excision of Dupuytren’s contracture with subtotal fasciectomy, left long finger and palm.
SURGEON: John Doe, MD
ANESTHESIA: Laryngeal mask airway.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
INSTRUMENT COUNTS: Correct.
SPECIMENS: One to pathology.
TOURNIQUET TIME: 55 minutes.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male who has had Dupuytren’s disease in both hands for some time, worse on the left than the right. He desired excision and contracture release and willingly signed informed consent after the risks, benefits, and potential complications had been explained to him. All questions were answered and no guarantees were given.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed supine on the operating table. After an adequate level of laryngeal mask anesthetic had been administered as well as a preoperative dose of antibiotics had been given, the left upper extremity was sterilely prepped and draped in the usual sterile fashion. The extremity was elevated, exsanguinated, and the tourniquet was inflated to 250 mmHg.
At this point, a Bruner style incision was made from the tip of the long finger down to the mid palmar area using a 15 blade. Skin flaps were carefully elevated off the prominent cord of Dupuytren’s over the ulnar border of the left long finger. Starting in the palm, the neurovascular bundles were identified on the ulnar side first and dissected from proximal to distal throughout the length of the finger.
Once they had been identified and dissected away from the overlying Dupuytren’s tissue, we began to excise the Dupuytren’s tissue starting in the palm and excising as we went along, going on the deep ulnar gutter of the finger. As we excised this, the contracture was released and much more extension was obtained, specifically at the proximal interphalangeal joint.
Once the Dupuytren’s tissue had been released and excised along the ulnar border of the long finger and the specimen collected, attention was directed toward the radial side, and we repeated this step on the radial side dissecting out the neurovascular bundle, this time from distal to proximal, releasing and excising Dupuytren’s tissue along the radial border of the long finger as well. This allowed the finger to get into full extension.
There were then several nodules in the palm on either side of the long finger ray that we dissected by lifting the skin edges and dissecting around the neurovascular bundles in the area of the mid and distal palmar creases. These were all then gathered together and passed off as one specimen. We palpated the finger and palm. There were no large nodules left. The patient’s finger was easily extended into full extension, and there was no need for a proximal interphalangeal joint capsular release.
The wound was then thoroughly irrigated and the skin closed using 5-0 nylon. A digital block of 0.25% plain Marcaine was administered. A sterile dressing and volar extension splint was applied. The patient was extubated and taken to the recovery room in stable condition. He will be discharged home on p.o. pain medicine, and follow up in 10 days.
