resident:matt_iorio
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| resident:matt_iorio [2021/04/22 15:45] – [Cubital Tunnel with Transposition] jonathan | resident:matt_iorio [2024/12/20 11:14] (current) – jerry | ||
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| It's busy. Between 40-60 patients on Tuesdays for Hand.\\ | It's busy. Between 40-60 patients on Tuesdays for Hand.\\ | ||
| You need to be extremely concise. "55 yo RHD woman with CTS. I want to order an EMG." | You need to be extremely concise. "55 yo RHD woman with CTS. I want to order an EMG." | ||
| + | Ask Kayla or Dan to pull meds for injections. He uses 1 cc dex and 1 cc lidocaine mixture for everything.\\ | ||
| + | You could potentially ask for pyxis access to do it yourself.\\ | ||
| + | \\ | ||
| + | How to roll a Dr. Iorio Bulky Jones:\\ | ||
| + | These are usually for lower extremity free flaps. Make sure you glue to vioptix down with dermabond. He holds it down and then cuts the tips of his gloves off. Roll the 1lb of cotton on. No need to break it in half. Next get the webril and use it to keep the cotton on. Now get the bias. Start at the heal. Once you get a roll around the heal, place a folded ABD under the heal for extra padding. Roll up the bias all the way up. Guess where the doppler stitch is and make a hole. Use the 1 slice of medipore tape to re-enforce the wall of the hole. Prop the heal up on blankets and pillows transversely at the foot of the bed. There should be no pressure under the popliteal fossa (the inflow).:\\ | ||
| + | |||
| + | Stoma Revision Protocol (as of 3/20/23).\\ | ||
| + | - Biopsy culture stoma (bx for colonization data) "label screening culture" | ||
| + | - Vanc/tobra intra op around stoma (1 vial vanc/1 vial tobra).\\ | ||
| + | - Augmentin 875/125 PO BID x14 days.\\ | ||
| + | - If PCN allergy, the Bactrim DS 800/160 PO BID and Flagyl 500 PO BID x 14 days.\\ | ||
| + | \\ | ||
| + | |||
| + | OI soft tissue stoma superficial infection: | ||
| + | - Linezolid 600mg PO BID x10 days.\\ | ||
| + | - Cipro PO BIX x 10 days.\\ | ||
| + | |||
| + | Order pain buster orderset:\\ | ||
| + | Use Pain Buster order set. - In hospital use CADD pump set at 0.2 Ropivicaine dose, the day of leaving hospital need order the pain ball(400cc) and talk with pharmacy to set rate at 6cc/hr\\ | ||
| + | |||
| + | Do not ever use Keesler method for tendon repair. Use cruciate method (4-strands, 1 knot) | ||
| ===== Operative Reports ===== | ===== Operative Reports ===== | ||
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| \\ | \\ | ||
| When using the knife, he doesn' | When using the knife, he doesn' | ||
| + | \\ | ||
| + | OI Stoma Revisions: Dc on Bactrim vs Doxy for 10 days; shrinkers are found in the equipment storage across from OR 2 (need to know length and circumference) as well as donning tubes to help put on the shrinkers. Helps to check chart to know what size patient was wearing before and may have to adjust from there. If you have questions, ask Maria Kouzmina (Stoneback' | ||
| ==== Medial Femoral Condyle Free Flap ==== | ==== Medial Femoral Condyle Free Flap ==== | ||
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| Attending Pearls (Learning points/Pimp Questions): | Attending Pearls (Learning points/Pimp Questions): | ||
| - | Remember that FPL tendon is coming around thenar muscles. Hold hand in almost an intrinsic plus position with finger tips pointed to ceiling. The A1 pulley is posterior to thenar area in this position. Incision should NOT be over thenar prominence. If so, you are too far radial/ | + | Remember that FPL tendon is coming around thenar muscles. Hold hand in almost an intrinsic plus position with finger tips pointed to ceiling. With the thumb and fingers almost at a 90 degree angle. The A1 pulley is posterior to thenar area in this position. Incision should NOT be over thenar prominence. If so, you are too far radial/ |
| + | DO NOT HOLD THE THUMB EXTENDED. that brings the nerves up. Hold it with IP flexion in a resting position.\\ | ||
| \\ | \\ | ||
| OR tips: Local w/ sedation. Upper arm tourniquet w/ webrill, tourniquet, 1000 drape. Close w/ 4-0 Nylon, xeroform/ | OR tips: Local w/ sedation. Upper arm tourniquet w/ webrill, tourniquet, 1000 drape. Close w/ 4-0 Nylon, xeroform/ | ||
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| Attending Pearls (Learning points/Pimp Questions): | Attending Pearls (Learning points/Pimp Questions): | ||
| - | OR tips: Local w/ sedation. Upper arm tourniquet w/ webrill, tourniquet, | + | OR tips: Local w/ sedation |
| </ | </ | ||
| </ | </ | ||
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| <WRAP half column> | <WRAP half column> | ||
| - | Tourniquet: | + | Tourniquet: |
| Drain: No\\ | Drain: No\\ | ||
| - | Sutures: monocryl\\ | + | Sutures: |
| - | Dressing: bulky dressing with thumb spica\\ | + | Dressing: bulky dressing with thumb spica splint\\ |
| + | |||
| + | Post-operative Protocol: | ||
| + | Splint for 4-6 weeks followed by progression of AROM to PROM.\\ | ||
| \\ | \\ | ||
| Iorio Tips: | Iorio Tips: | ||
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| \\ | \\ | ||
| - | Indications: | + | Indications: |
| We discussed the nature and pathophsiology of the diagnosis. We discussed treatment options and expectations in regards to potential outcomes, including the needs for secondary procedures or revisions. | We discussed the nature and pathophsiology of the diagnosis. We discussed treatment options and expectations in regards to potential outcomes, including the needs for secondary procedures or revisions. | ||
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| Prefers a longitudinal incision unless it's a very young female patient for cosmetic reasons.\\ | Prefers a longitudinal incision unless it's a very young female patient for cosmetic reasons.\\ | ||
| Transposes EPL. Sutures wrist capsule back together with 3-0 monocryl.\\ | Transposes EPL. Sutures wrist capsule back together with 3-0 monocryl.\\ | ||
| - | What interval dose he use?\\ | + | What extensor |
| + | After transposing EPL, will go longitudinally between DEC 2 & 4 and then elevate off the compartments. He is ALWYAS abele to close this. No stupid step cuts. Repair this at the end. 3-0 monocryl.\\ | ||
| + | Incise joint capsule and elevate off bones. Repair some of this at end with 3-0 monocryl.\\ | ||
| Take bone out with rongeur and freer and knife.\\ | Take bone out with rongeur and freer and knife.\\ | ||
| Most important ligament to preserve is RSC (Radioscaphocapitate). All the ligaments that will support the wrist are now volar.\\ | Most important ligament to preserve is RSC (Radioscaphocapitate). All the ligaments that will support the wrist are now volar.\\ | ||
| Useful positions are flap and bumped up to flex the wrist using a blue towel bump.\\ | Useful positions are flap and bumped up to flex the wrist using a blue towel bump.\\ | ||
| x-ray at the end. Take one image distracted to make sure the bone fragments are gone. Take the next image for stability. AP to show capitate sits in lunate fossa. Lateral flexed and extended to make sure the patient doesn' | x-ray at the end. Take one image distracted to make sure the bone fragments are gone. Take the next image for stability. AP to show capitate sits in lunate fossa. Lateral flexed and extended to make sure the patient doesn' | ||
| - | Splint is very important. WRIST needs to be ulnarly deviated and the wrist in slight extension. MCPs free. Hand elevation pillow.\\ | + | Splint is very important. Volar dorsal. WRIST needs to be ulnarly deviated and the wrist in slight extension. MCPs free. Hand elevation pillow.\\ |
| This allows the capitate to stay in the lunate fossa of the radius.\\ | This allows the capitate to stay in the lunate fossa of the radius.\\ | ||
resident/matt_iorio.1619120744.txt.gz · Last modified: 2021/04/22 15:45 by jonathan