DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Pyogenic granuloma, right knee.
POSTOPERATIVE DIAGNOSIS:
Pyogenic granuloma, right knee.
OPERATION PERFORMED:
Incision and debridement of right knee pyogenic granuloma.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General laryngeal.
TOURNIQUET TIME: 35 minutes.
ESTIMATED BLOOD LOSS: Minimal.
CULTURES: taken.
INDICATION FOR PROCEDURE: This is a (XX)-year-old pleasant patient, who had a total knee performed here several years ago and has done well. The patient has rheumatoid arthritis, and unfortunately, the rheumatoid arthritis has been very difficult to control. However, the patient has started to complain of some pain, swelling and redness anteromedially around the knee, and a biopsy of the knee done by the primary care physician revealed a pyogenic granuloma. The patient is now here for an open debridement and knee irrigation. The patient’s knee exam is normal, and there is no evidence that the knee is involved.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room after signing a consent form. In the holding area, the patient’s right knee was scrubbed with Betadine. The patient was given 2 grams of Ancef IV piggyback. The patient was then brought into the operating room and placed supine on the operating room table. General laryngeal anesthesia was administered by the anesthesia staff. The patient then had a tourniquet placed high on the right thigh. An Esmarch tourniquet was used to exsanguinate the right lower extremity. The right lower extremity was prepared in the usual sterile fashion per protocol.
The patient’s knee was then flexed over a knee roll, and a straight midline incision was made utilizing the bottom distal third of the incision. Sharp dissection was made down to the capsule, but the capsule was not entered. The granuloma site was identified. There was some mild exudative material around the granuloma site, but really no discernible granuloma or abscess. Curettes and rongeurs were used to debride this area, but the hip was not entered, and the capsule was not invaded.
The wound was then copiously irrigated with antibiotic pulsatile lavage and closed anatomically with the deep tissue closed with #1 Vicryl figure-of-eight suture, subcutaneous tissues with 2-0 Vicryl undyed interrupted sutures, and the skin was closed with staples. Sterile dressings were applied. A compressive-type Ace bandage from the toes to the groin was placed. The tourniquet was released. The tourniquet time was 35 minutes. The patient was awakened and taken to the recovery room in stable condition.
