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resident:stephanie_malliaris [2021/08/19 13:04] – taylorresident:stephanie_malliaris [2021/08/19 13:13] (current) – taylor
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 <WRAP group> <WRAP group>
 <WRAP half column> <WRAP half column>
-  
 POSTOPERATIVE DIAGNOSES: POSTOPERATIVE DIAGNOSES:
 1.  Crush injury to hand. 1.  Crush injury to hand.
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 4.  A 90% transection FDP to index finger, zone 1. 4.  A 90% transection FDP to index finger, zone 1.
 5.  Laceration to ring finger and small finger volar aspect. 5.  Laceration to ring finger and small finger volar aspect.
- +
 PROCEDURES: PROCEDURES:
 1.  Washout and excisional debridement of crush wound to right hand index finger,  1.  Washout and excisional debridement of crush wound to right hand index finger, 
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 4.  Closure of simple laceration, right ring finger and small finger. 4.  Closure of simple laceration, right ring finger and small finger.
    
-\\DESCRIPTION OF PROCEDURE:  The patient was brought to the operating room.  He + 
 +DESCRIPTION OF PROCEDURE:  The patient was brought to the operating room.  He 
 remained on the stretcher.  The right upper extremity was put on a hand table.  Bony remained on the stretcher.  The right upper extremity was put on a hand table.  Bony
 prominences were padded.  SCD boots were placed.  Preoperative antibiotics were  prominences were padded.  SCD boots were placed.  Preoperative antibiotics were 
 given.  General anesthesia was administered.  The right upper extremity was prepped  given.  General anesthesia was administered.  The right upper extremity was prepped 
 and draped in the usual sterile fashion with a tourniquet on the upper arm. and draped in the usual sterile fashion with a tourniquet on the upper arm.
- +
 Surgical pause was performed in accordance with hospital regulations.  The right  Surgical pause was performed in accordance with hospital regulations.  The right 
 upper extremity was elevated and exsanguinated using Esmarch bandage and the  upper extremity was elevated and exsanguinated using Esmarch bandage and the 
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 remained intact and had not been injured in the accident.  The area was irrigated  remained intact and had not been injured in the accident.  The area was irrigated 
 and the Bruner flaps were placed over the tendon. and the Bruner flaps were placed over the tendon.
- +
 We turned our attention to the index finger.  The laceration was irrigated and  We turned our attention to the index finger.  The laceration was irrigated and 
 excisional debridement was performed of skin and subcutaneous tissue.  This was done excisional debridement was performed of skin and subcutaneous tissue.  This was done
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 was then used for further strength repair at the tendon laceration site.  This was  was then used for further strength repair at the tendon laceration site.  This was 
 then irrigated. then irrigated.
- +
 We then did the excisional debridement of the skin and subcutaneous tissue of the  We then did the excisional debridement of the skin and subcutaneous tissue of the 
 long finger.  The nonviable edges were trimmed.  This was approximately 3 x 0.5 cm  long finger.  The nonviable edges were trimmed.  This was approximately 3 x 0.5 cm 
 area.  The debridement was skin and subcutaneous tissue and it was done with an  area.  The debridement was skin and subcutaneous tissue and it was done with an 
 Adson. Adson.
- +
 We then turned our attention to the ring and small fingers.  The 2 other lacerations We then turned our attention to the ring and small fingers.  The 2 other lacerations
 were explored, tendons were intact in the ring finger and in the small finger.  It  were explored, tendons were intact in the ring finger and in the small finger.  It 
 did not extend into the flexor sheath either.  Excisional debridements were  did not extend into the flexor sheath either.  Excisional debridements were 
 performed, 1 cm x 0.5 cm for of these lacerations. performed, 1 cm x 0.5 cm for of these lacerations.
- +
 The Irrisept wound irrigation system was used, 500 mL to irrigate all four of the  The Irrisept wound irrigation system was used, 500 mL to irrigate all four of the 
 lacerations.  We then released the tourniquet and normal perfusion returned to the  lacerations.  We then released the tourniquet and normal perfusion returned to the 
 hand and fingers.  Hemostasis was ensured and then the incisions were closed with  hand and fingers.  Hemostasis was ensured and then the incisions were closed with 
 interrupted 4-0 nylon sutures. interrupted 4-0 nylon sutures.
- +
 A dorsal blocking splint was placed after bacitracin, Adaptic, and sterile Webril. A dorsal blocking splint was placed after bacitracin, Adaptic, and sterile Webril.
-  
  
 </WRAP> </WRAP>
  
 <WRAP half column> <WRAP half column>
-Anesthesia: Local injection  +Irrigation with Irrisept 500mL 
-Tourniquet: Sterile  + 
-Postoperative care: Elevate extremity, f/u 1-2 weeks, OT referral for flexor rehab protocol+Tourniquet: Sterile; arm 
 + 
 +Drain: None 
 + 
 +Sutures:  
 +- Skin: 4-0 nylon 
 +- FDP zone 2: modified Kessler with 3-0 Supramid, epitendinous with 6-0 Prolene 
 +- FDP zone 1: mini Mitek with 2-0 suture was drilled and placed into volar aspect of distal phalanx, 2-0 suture to repair tendon to distal phalanx, 6-0 prolene to reinforce 
 + 
 +Dressing: Bacitracin, Adaptic, Webril, dorsal blocking splint\\ 
 + 
 +Anatomy: FDP/FDS insertions, zones of injury, Camper's chiasm, neurovascular bundles\\ 
 + 
 +Post-operative care: Elevate LUE, splint care, f/u 1-2 weeks, OT referral for flexor rehab protocol\\ 
 + 
 +Attending Pearls (Learning points/Pimp Questions): N/A\\ 
  
 </WRAP> </WRAP>
resident/stephanie_malliaris.1629392694.txt.gz · Last modified: 2021/08/19 13:04 by taylor
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