DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Traumatic pseudoaneurysm of the right subclavian artery.
POSTOPERATIVE DIAGNOSIS:
Traumatic pseudoaneurysm of the right subclavian artery.
PROCEDURE PERFORMED:
Upper sternal split with repair of right subclavian artery pseudoaneurysm.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None apparent.
DISPOSITION: To postanesthesia care unit in satisfactory condition.
INDICATIONS FOR PROCEDURE: The patient is a (XX)year-old male who suffered a stab wound to the right back with deep penetration and a partial laceration of the proximal right subclavian artery. Prior attempt at endovascular approach to the lesion revealed the lesion to be in such close proximity to the vertebral artery that an endovascular approach was not safely achievable. Dr. Jane Doe of Vascular Surgery requested my assistance in an upper sternal split to provide proximal control of the brachiocephalic artery and/or proximal subclavian artery to facilitate repair of this injury. The risks, benefits, and alternatives were discussed with the patient. Informed consent was obtained.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. Following smooth induction of general endotracheal anesthesia, the anterior neck, chest, and shoulders were prepared and draped in the usual sterile fashion. Preoperative antibiotics had been administered. An upper median sternotomy incision was performed from the suprasternal notch to the mid sternal level. Sharp dissection was carried down through the pectoral fascia. The sternomanubrial junction was identified and then the rightward half of the sternomanubrial junction was opened with Bovie cautery.
The manubrium was then split in the midline with an oscillating saw. Hemostasis of the marrow was obtained with thrombin and Gelfoam. A Tuffier chest retractor was placed and slowly opened. The midline fascia was opened. The brachiocephalic artery was identified and isolated for proximal control.
Following repair of the vessel, the wound was inspected. There was good hemostasis. The sternum was then reapproximated with three #6 stainless steel wires. A figure-of-eight wire was used for approximation of the lower manubrium and sternomanubrial junction, and then, two simple wires for approximation of the mid and proximal manubrium. The fascia was closed with 2-0 Vicryl sutures. The subcutaneous layer was closed with 3-0 Vicryl sutures. The skin was approximated with 4-0 Monocryl subcuticular stitches. The patient awoke from general anesthesia without difficulty. He was extubated and transported to the postanesthesia care unit in satisfactory condition.
