DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Benign bone neoplasm, left long finger, proximal phalanx.
POSTOPERATIVE DIAGNOSIS:
Benign bone neoplasm, left long finger, proximal phalanx.
OPERATION PERFORMED: Excision and curettage of benign bone neoplasm, left long finger, proximal phalanx; distal radius autologous bone graft; Grafton to distal radius donor site; AlloDerm dermal cellular graft reconstruction of long finger periosteum.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMENS: Benign bone neoplasm for frozen and permanent.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was identified in the holding area. Appropriate surgical limb and site along with donor site were confirmed, marked, and initialed. The patient was brought to the operating room and placed in supine position on the operating room table. The left upper limb was prepped and draped in routine fashion. The upper limb was exsanguinated with an Esmarch bandage and a previously placed well-padded pneumatic tourniquet was inflated to 250 mmHg and 3.5 loupe magnification was used throughout.
An S-shaped incision was made over the dorsal aspect of the left long finger, proximal phalanx, deep to the skin and subcutaneous tissue. Small bleeding points were controlled by bipolar cautery. The extensor tendon was split in the midline and retracted radially and ulnarly. Care was taken to preserve the periosteal layer. Fluoroscopy was used to confirm the outlines of the tumor. A cortical window was then made using a Lindemann bur. This measured approximately 5 mm in width x 1 cm in length. It was centered over the defect. Care was taken to preserve the dorsal periosteum. With final removal of the window, the tumor was unroofed. This appeared to be a cartilaginous-type tumor consistent with enchondroma. A portion of the tumor was sent for frozen section and permanent section. Based upon the frozen section, the pathologist’s reading was benign neoplasm. Meticulous curetting of the enchondroma was then carried out. This consisted of a combination of use of curettes, suction, and a Kleinert-Kutz type elevator.
An arthroscope was also used to examine the cavity to ensure that all tumors had been removed. The cavity was then copiously irrigated with saline. All instrumentation that had been used for the tumor resection was now removed from the field. We elected to use distal radius autograft. The incision was made just proximal to Lister tubercle. Dissection then proceeded down to the dorsal cortex. Corticotomy was made. Cancellous bone graft was then harvested using the correct bone biopsy technique. Following this, the skin wound was closed with intracuticular 4-0 Prolene suture. The cancellous bone was then packed into the proximal phalanx cavity.
Prior to closure of the distal radius wound, Grafton had been used in the donor site defect. The harvested bone graft completely obliterated the tumor cavity. Fluoroscopy was used to confirm complete obliteration of the cavity. The cortex was then replaced and the periosteum was repaired with interrupted 6-0 Prolene. A piece of thin AlloDerm was used to reconstruct the periosteal layer. This was reconstituted in saline in normal fashion. It was cut slightly larger than the periosteal defect and sutured in place with running over-and-over 6-0 Prolene. The extensor tendon was then repaired with a 4-0 Supramid suture. Tourniquet was deflated. The single wound was closed with interrupted 5-0 nylon. The wrist wound was steri-stripped. The wound was dressed with antibiotic ointment and Adaptic. A bulky dressing was applied and reinforced with a palmar fiberglass splint. The patient tolerated the procedure well, was awakened in the operating room, and transported to the recovery room in stable condition.
