DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right traumatic above-the-knee amputation, traumatic open wound.
POSTOPERATIVE DIAGNOSIS: Right traumatic above-the-knee amputation, traumatic open wound.
OPERATION PERFORMED:
1. Staged irrigation and debridement.
2. Delayed primary closure of open above-the-knee amputation.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
DRAINS: One Penrose drain, left medial aspect of the wound.
SPECIMENS: None.
TUBES: None.
ESTIMATED BLOOD LOSS: 150 mL.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: Stable to PACU.
TOURNIQUET TIME: Not utilized.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female who was involved in a motorcycle accident approximately two days prior. The patient sustained a traumatic above-the-knee amputation. She was seen and evaluated in the emergency room and taken to the operating room where urgent completion amputation was performed, and the wound was left open due to extensive amount of soft tissue damage as well as contamination of the wound. She was monitored in the ICU for two days, kept on antibiotics, and then brought back to the operating room for revision and closure. All the details, the risks, and expected benefits of the procedure were explained, and informed consent was obtained.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed supine on the operating table. Preoperative antibiotics in the form of 1 gram of Ancef was administered. The patient’s dressings were then taken down and examined. The leg was prepped with Betadine, washed with Betadine paint through the open wound, and the patient was draped in the usual standard sterile fashion.
At this time, the wound was inspected and small amounts of necrotic and nonviable tissues were debrided sharply. The skin edges were also debrided sharply down to brisk viable tissue. Three liters of normal saline and pulsatile lavage was then utilized for irrigation of the wound, at which time additional debridement was undertaken for parts of the wound that were needed.
The sciatic nerve was identified in the traumatic wound, and it was dissected back deep into the tissues and incised sharply. All bleeders were then cauterized, and two bleeders were tied off with 2-0 silks. Hemostasis was noted to be good. An additional six liters of pulsatile lavage were utilized, three of those liters containing bacitracin.
At this point, the wounds were noted to be fresh and clean. There was no sign of any debris or nonviable tissue. Bone ends had been debrided with a curette, and the abductor musculature was noted to be attached securely to the femur. The fascia was then isolated and dissected out, and a layered closure of the fascia was obtained with 0 PDS interrupted sutures.
The skin was then noted to be in good alignment. The skin edges were trimmed down to facilitate the wound being closed primarily. The skin was closed with interrupted 2-0 PDS sutures and then the final layer was closed with 3-0 nylon interrupted sutures. The wounds were then washed and dried, dressed with bacitracin, Adaptic, dry gauze. A Kerlix and an Ace wrap were utilized and taped to the patient’s leg. The patient was then awoken from anesthesia, transferred to the operative bed, and transferred to the SICU in serious condition. The plan is to look at the wound in two days and remove the Penrose dressing.
