DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Degenerative arthritis, right thumb carpometacarpal joint.
2. Flexor stenosing tenosynovitis, right thumb.
POSTOPERATIVE DIAGNOSES:
1. Degenerative arthritis, right thumb carpometacarpal joint.
2. Flexor stenosing tenosynovitis, right thumb.
OPERATION PERFORMED:
1. Excision arthroplasty, right thumb carpometacarpal joint with ligament reconstruction by tendon transfer.
2. Release, thumb flexor tendon sheath.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
SEDATION: Axillary block.
DESCRIPTION OF OPERATION: The patient was brought to the operating room where an axillary block was placed by the anesthesia department. The right upper extremity was prepped and draped in the usual manner for hand surgery. Under tourniquet control using loupe magnification, a transverse incision was made at the thumb MP flexion crease. Subcutaneous tissue was bluntly divided. The underlying flexor tendon sheath was exposed. The area of the neurovascular bundles was carefully protected. The entire A1 was released from its proximal edge up to its distal edge. A proximal dissection released any bands or constrictions. There was a thickening in the flexor pollicis longus. The wound was irrigated and closed with nylon suture.
An incision was then made at the base of the thumb and extended to the level of the CMC joint. Subcutaneous tissue was bluntly divided. Underlying neurovascular structures were protected. The extensor pollicis brevis was identified. This was a very large tendon. This was released to allow retraction. The tissues overlying the CMC joint and trapezium were bluntly dissected to identify and later protect the area of deep vascular structure. An incision was then made along the periosteum of the base of the thumb metacarpal across the CMC joint to the trapezium. This area was then exposed by subperiosteal dissection. The trapezium was then split with an osteotome and removed in toto with a rongeur. The flexor carpi radialis was protected. The volar beak and volar sulcus were debrided. The interval between the thumb metacarpal base and the index metacarpal base was also debrided.
A drill hole was then placed into the dorsal base of the thumb metacarpal down to the medullary canal and exited through the articular surface. The flexor carpi radialis was then harvested through a transverse incision on the volar radial forearm. The tendon was then pulled distally into the arthroplasty site. There was a very tiny adhesion distally to its insertion. The flexor carpi radialis was then split in two. One slip was pulled through the hole in the articular surface and then out dorsally through the hole at the base of the metacarpal. A square knot was then placed while providing longitudinal traction at the thumb. The knot was secured with nylon sutures. The remaining flexor carpi radialis was then packed into the arthroplasty site. The capsule was securely repaired with Vicryl suture. The wound was irrigated and closed with nylon suture. The wound was sterilely dressed. Bulky compression dressing was applied, and a protective plaster splint was applied. The operative course was uneventful with no complications. The patient tolerated the procedure well and was brought to recovery in good condition.
