DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right ring finger mass.
POSTOPERATIVE DIAGNOSIS: Right ring finger mass.
PROCEDURES PERFORMED:
1. Excision right ring finger mass, volar aspect, just distal to the DIP flexion crease.
2. Right ring finger digital block.
SURGEON: John Doe, MD
ANESTHESIA: Right ring finger digital block.
COMPLICATIONS: None.
SPECIMENS: Right ring finger mass for permanent pathology.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old Hispanic female who has previously been treated for right hand Dupuytren’s palmar fibromatosis. She presented to the office today with a painful growing mass in the volar aspect of the right ring finger just distal to the DIP flexion crease. This appeared to be a pyogenic granuloma, and there was some overlying epidermis. The patient was desirous of surgical excision. After discussion of risks and benefits, the patient elected to proceed with the above.
OPERATIVE FINDINGS: The mass was ellipsed in its entirety and traced to a small stalk extending proximally. This did not go deep beneath the subcutaneous fat, and it was removed in its entirely. It was not attached to the digital nerve or digital vessel. It did not emanate from the flexor tendon sheath or the underlying DIP joint. It was consistent with a pyogenic granuloma.
DESCRIPTION OF OPERATION: After obtaining informed consent and identifying correct patient and correct operative site, the patient was taken to the operating suite and placed supine on the operating table. The right hand and upper extremity was then placed on the hand table. She received a digital block at the base of the ring finger using 1% lidocaine mixed with 0.5% Marcaine in a 50:50 mixture. Right hand and upper extremity was then prepped and draped in the usual sterile fashion. A Penrose drain was applied to the base of the ring finger to act as a tourniquet.
The easily visualized mass was ellipsed out with overlying skin, and dissection was carried down through the skin and subcutaneous tissue. Then gentle and blunt dissection was utilized around the mass removing it in its entirety with the above findings noted. The tourniquet was deflated. Excellent circulation returned to her digits. Hemostasis was obtained with gentle direct pressure and bipolar electrocautery. The radial digital nerve was visualized and identified, the mass was near it, but was not emanating from it nor from its adjacent digital vessel.
The bed was then irrigated with normal saline, the skin edges were reapproximated with 4-0 Prolene suture. It was dressed with Xeroform and a lightly compressive digital dressing. The patient was taken to the recovery room in stable condition and tolerated the procedure without difficulty.
