Plastics

• Massachusetts Institute of Technology, S.B. Physics (1969-1973)
  
• University of California, Berkeley M.A Physics (1973-1978)
  
• Standford University, M.S. Mech. Engineering (1978-1979)
  
• Unordered List ItemAlbert Einstein College of Medicine, M.D. (1979-1983)
  

• Internship: General Surgery - Albert Einstein College of Medicine, Montefiore Medical Center (1983-1984)
  
• Residency: General Surgery - Albert Einstein College of Medicine, Montefiore Medical Center (1984-1987)
  
• Residency: Plastic Surgery - Albert Einstein College of Medicine, Montefiore Medical Center (1987-1989)
  
• Fellowship: Hand and Microvascular Surgery, Division of Plastic and Reconstructive Surgery, University of Colorado Health Science Center (1989-1990)
  

Clinical Interests:
(1) Microsurgical Reconstruction

• Replantation
• Development of Innovative transfers to resolve would coverage

(2) Hand Trauma

• Surgical application
• Rehabilitation following surgery

(3) Dupuytren's contractures
(4) Arthroscopy
(5) Swanson implant antroplastics
(6) Carpal tunnel and replantations
(7) Reconstruction of the residual of burn - hand/upper extremity
(8) Hand and bone disorders common to the dialysis population
(9) Animal bites (monkeys, dogs, cats etc.) on the human hand
(10) Analysis of electromyographic indicators for release of the entrapped median nerve

Dr. Gordon Publications

Why isn't the bovie working? Because we infilitrated with local and it's too wet.

Loupe magnification for ALL cases. Yes, even breast reductions.

OR
Very particular so pay attention

arm out and turned 90
tourniquet upper arm- with lots of web well unless stated otherwise

Draping-he will have an xtra large sheet that he cuts
arm in stockinette
1. mayostand on hand table (paper side down)
2. half of the xtra large drape on hand table
3. blue towel wrapped around arm help by penetrating towel clamp
4. long sheet over patient - held in place by 4 non penetrating towel clamps

“If there is pus always collect culture data Uses loupes for all cases”

Pilar syndrome for post-CTR pain

arm out and turned 90
tourniquet on forearm- with lots of web well unless stated otherwise

Draping-he will have an xtra large sheet that he cuts
arm in stockinette
1. mayostand on hand table (paper side down)
2. half of the xtra large drape on hand table
3. blue towel wrapped around arm help by penetrating towel clamp
4. long sheet over patient - held in place by 4 non penetrating towel clamps
-He will mark the incision.
-Uses Knife to cut until fat is seen, 2 ski hooks
-Bovie and smooth pickup to buzz vessels
-then he uses ragnels and sens and you use litler scissors to dissect doen to transverse carpal ligament.
-start proximal, sweep ulnar–> radial with freer
-litler to push cut the proximal transverse carpal ligament
then distal- litler until Kaplan's line

USES VICRYL TO CLOSE DEEP DERMAN
then 5-0 nylon interupted

Special equipment: Bone anchor
Sutures: 2-0 fiber wire for tendon reconstruction, 5-0 nylon for skin closure
Notes: Removes trapezium whole. (ie. does not use rongeur unless a piece breaks)

Things to note are there is a template for the spanning plates so you can use this to first make sure that you'll be in the right spot. You're going to make three incisions, one over the metacarpals. You can choose a second or third Dr. Gordon prefers the third over the just the aspect of the distal radius and then a mid distal mid radius.

Things that you will encounter at the most distal incision - juncturiae tendinae. Takes the extensor tendons ulnarly.
Middle incision - Will encounter EPL… Make sure it is elevated so it's not crushed.
Proximal incision - May encounter APL which has a very big tendon with multiple sheaths.

The most proximal screws are a different size than the distal screws. The incisions were closed with 4-0 vicryl although he usually uses 5-0 vicryl, and a 5-O monocryl sub-cuticular layer.

Dressing: Benzoin, steri-strips, tegaderm, soft kerlix, splint.

Suture: 4-0 vicryl deep dermal, 4-0 Monocryl subcuticular
Dressing: Steristrips crossing wound with benzoin, pressure dressing

After induction of general anesthesia, the patient was placed into a prone position with padding and had her back prepped and draped. Preoperative skin markings consisted of a 5 cm transverse skin incision directly over the palpable mass. The scalpel was then used to incise along the marked lines going down through the skin into subcutaneous tissues, whereafter the rest of the dissection was performed with loupe magnification using a combination of electrocautery as well as gentle blunt dissection to dissect the mass from the surrounding tissues. Once in the subcutaneous plane, there appeared to be a multilobulated lesion that was contained in this space that was felt to be likely to be consistent with a lipoma. Gentle blunt dissection was then performed at the periphery of the mass, but the mass was poorly encapsulated from the surrounding tissues and dissection was slow to proceed. The mass was eventually isolated from the surrounding tissues and no further presence of the mass was noted on clinical exam. The mass seemed to extend all the way down to the fascia. After verifying complete excision of the mass, the wound was meticulously checked for hemostasis with electrocautery, and then closure of the cutaneous wound was accomplished with multiple deep dermal sutures of 4-0 Vicryl, followed by a running 4-0 Monocryl subcuticular stitch in the skin. Dressings consisting of benzoin, Steri-Strips, and Tegaderm were applied, followed by a modest compressive bandage with 4 x 4's and Medipore tape.

Dr. Gordon's Purple Sheet Hand Exam

Injections pure kenalog into proximal phalanx at 45 degree angle between finger and palm. (ie. the needle is pointing distally in the direction of the distal finger tip.) Go all the way down to bone and inject WITHOUT resistance. Place a bandaid dressing.

OR Tips: Local w/ sedation vs. Bier block. Forearm tourniquet w/ webrill, tourniquet, 1000 drape. Prop arm on suction canister wrapped w/ blue drape packaging. Close w/ 5-0 Vicryl, 5-0 Nylon, kerlix, short arm splint, 4” ace.

Immediate Post Op Orders

Goals:

• Off work x 2 days
• Elevate wrist above elbow x 1 week
• Keep surgical dressings clean/dry/intact
• Finger motion as tolerated, otherwise no use of hand
• Follow up 1 week post op
• POST OP PROTOCOL ORDERS

Work Restrictions

• 0-1 weeks: No use of operative hand
• 1-4 weeks: 5 lb lifting limit, no pushing or pulling

1 week Post-surgery

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal

1. Remove every other suture to determine integrity of incision – if any gapping or if diabetic, have patient return per therapist discretion for remaining suture removal (on Physician Extender schedule)

• OT Order

1. Custom volar wrist splint
2. Initiate CTR post op protocol

OT (if ordered beyond PE duties on 1st post op visit)

• 2-4 weeks post op

1. Finger and wrist ROM

• 4+ weeks post op

1. Scar desensitization/massage
2. Putty use
3. Strengthening and ROM as tolerated

4 weeks

• Second follow up visit (schedule with MD)
• Typically allows full unrestricted use

12 weeks

• Final Follow up visit (schedule with MD)
• Continue with follow up at 6 week interval if 2 point still expanded

OR Tips: Block w/ sedation. Upper arm tourniquet w/ webrill, tourniquet, 1000 drape. Prop arm on suction canister wrapped w/ blue drape packaging. Close w/ 3-0/4-0 Monocryl, Steri strips, kerlix, Wrapped thumb spica splint, 4” ace.

Immediate Post Op Orders

Goals:

• Keep splint/dressing clean/dry/intact until follow up
• Elevate/ice wrist x 7 days
• May move fingers as splint allows – NO thumb motion
• Off work x 2 days post op
• Follow up 7 days post op
• POST OP PROTOCOL ORDERS

Work Restrictions

• At 1 week post op can start typing (no thumb)
• No lifting more than 1-2 lbs prior to 1 week (no thumb assistance)

1 week Post-surgery

• Schedule 1st post op visit with Physician Extender
• X-Ray 3 views of operative thumb
• Wound Check
• Suture Removal

1. Remove every other suture to determine integrity of incision – if any gapping or if diabetic, have patient return per therapist discretion for remaining suture removal (on Physician Extender schedule)

• OT Order

1. Forearm based thumb spica zipper splint, thumb MP in ~ 20 degrees of flexion, IP free
2. Have patient schedule to begin therapy at 6 weeks post op

4 weeks

• Second follow up visit (Schedule with MD)

OT (start at 6 weeks)

• Zipper spica splint x 6 weeks
• Gentle circumduction, flexion, extension, abduction, opposition, retroposition of thumb as well as AROM of wrist
• Desensitization
• May remove splint for exercises and showering/light activity

OT Progression (10 weeks)

• Wean from splint – use only for heavy activity
• Start light strengthening with putty
• Ok to have splint off in home/controlled environment, splint on when out in community

12 Weeks

• Final MD visit
• Full use/fully weaned from splint (however can wear for aggressive sports, etc PRN)
• Continue w/ strengthening
• If no problems, d/c from OT to HEP

OR Tips: LMA. Upper arm tourniquet w/ webrill, tourniquet, 1000 drape. Prop arm on suction canister wrapped w/ blue drape packaging. Close w/ 3-0/4-0 Monocryl, steristrips, kerlix, 4” ace.

Immediate Post Op Orders

Goals:

• Keep surgical dressings clean/dry/intact
• Elevate x 1 week
• Finger motion as tolerated, otherwise no use of hand x 1 week
• POST OP PROTOCOL ORDERS

Work Restrictions

• No use of hand/arm x 1 week
• Starting at 1 week can typically start to use PRN

1 week Post-surgery

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal

1. Keep steri-strips/Tegaderm on until it falls off, or at least 2 weeks post op

• OT Order (PRN)

OT (if ordered beyond PE duties on 1st post op visit)

• A/AAROM

4 Weeks

• Second follow up visit (Schedule with MD)

12 Weeks

• Typically final MD visit

OR Tips: Local w/ sedation vs. Bier block. Forearm tourniquet w/ webrill, tourniquet, 1000 drape. Prop arm on suction canister wrapped w/ blue drape packaging. Close w/ Monocryl, kerlix, short arm splint, 4” ace.

Immediate Post Op Orders

• Keep surgical dressings clean/dry/intact
• Elevate x 1 week
• Finger motion as tolerated, otherwise no use of hand x 1 week
• NO thumb motion
• POST OP PROTOCOL ORDERS

Work Restrictions

• No use of hand/arm x 1 week

1 week Post-surgery

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal PRN (often does internal/dissolvable sutures)
• Forearm based thumb spica splint
• OT Order (PRN)

OT (if ordered beyond PE duties on 1st post op visit – start 3 weeks post op)

• ROM
• Scar management/desensitization

4-6 weeks

• Second follow up visit (Schedule with MD

12 Weeks

• Typically final MD visit

OR Tips: Block w/ sedation. Upper arm tourniquet w/ webrill, tourniquet, 1000 drape. Prop arm on suction canister wrapped w/ blue drape packaging. Close w/ 5-0 Vicryl, 5-0 Nylon (Monocryl if younger or female), kerlix, short arm splint, 4” ace.

Immediate Post Op Orders

• Keep surgical dressings clean/dry/intact
• Elevate x 1 week
• Finger motion as tolerated, otherwise no use of hand x 1 week
• POST OP PROTOCOL ORDERS

Work Restrictions

• No use of hand/arm x 1 week

1 week Post-surgery

• Schedule 1st post op visit with Physician Extender
• X-rays (3 views of wrist)
• Wound Check
• Suture Removal
• Circumferential orthosis
• OT Order

OT

• AROM (AFTER verification of acceptable bony alignment on xray by MD).
• Edema management

4 weeks

• Second follow up visit (Schedule with MD)
• X-rays (3 views of wrist)
• Progression of OT dependent on clinical exam – MD will enter updated orders

8 weeks

• Third follow up visit (Schedule with MD)
• X-rays (3 views of wrist)
• Progression of OT dependent on clinical exam – MD will enter updated orders

OR Tips: Local w/ sedation vs. Bier block. Forearm tourniquet w/ webrill, tourniquet, 1000 drape. Prop arm on suction canister wrapped w/ blue drape packaging. Close w/ 5-0 Vicryl, 5-0 Nylon, kerlix, short arm splint, 4” ace.

Immediate Post Op Orders

• Keep surgical dressings clean/dry/intact
• Elevate x 1 week
• Finger motion as tolerated, otherwise no use of hand/arm x 1 week
• POST OP PROTOCOL ORDERS

Work Restrictions

• No use of hand/arm x 1 week

1 week Post-surgery

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal
• Volar wrist orthosis
• Ok to return to activities with splint on after 1 week post op
• Wean from splint at 2 weeks post op and start A/AA/gentle PROM
• OT Order (PRN)

OT (if ordered beyond PE duties on 1st post op visit – begin at 2 weeks post op)

• A/AA/Gentle PROM
• Scar/Edema management

4 weeks

• Second follow up visit (Schedule with MD

12 weeks

• PRN follow up visit with MD

OR Tips: Block w/ sedation. Forearm tourniquet w/ webrill, tourniquet, 1000 drape. Prop arm on suction canister wrapped w/ blue drape packaging. Close w/Monocryl, kerlix, Forearm based intrinsic plus splint, 4” ace. Immediate Post Op Orders * Keep surgical dressings clean/dry/intact * Elevate x 1 week * No use of hand/arm x 1 week * POST OP PROTOCOL ORDERS Work Restrictions * No use of hand/arm x 1 week 1 week Post-surgery * Schedule 1st post op visit with Physician Extender] * X-rays (3 views of hand) * Wound Check * Suture Removal * Forearm based orthosis, MPs in mid-flexion, IPs in extension * OT Order OT * AROM (AFTER verification of acceptable bony alignment on xray by MD). 4 weeks * Second follow up visit (Schedule with MD) * X-rays (3 views of hand) 8 weeks * Third follow up visit (Schedule with MD) * X-rays (3 views of hand) ====Trigger Finger Release==== OR Tips: local w/ sedation. Forearm tourniquet w/ webrill, tourniquet, 1000 drape. Prop arm on suction canister wrapped w/ blue drape packaging. Close w/ 5-0 Vicryl, 5-0 Nylon, kerlix, short arm splint, 4” ace.
Immediate Post Op Orders * May remove dressing 4-5 days post op * Finger motion and typing as tolerated * Apply Band Aid * Keep dry, no ointments * POST OP PROTOCOL ORDERS Work Restrictions * Depends on job requirements 14 Days Post-surgery * Schedule 1st post op visit with Physician Extender * Wound Check * Suture Removal * Instruct in scar massage to begin 2-3 days after suture removal * Instruct in gentle AROM * Edema management PRN * OT Order (PRN) OT (if ordered beyond PE duties on 1st post op visit) * As above 4 weeks * Second follow up visit (Schedule with MD) 12 weeks * Typically final follow up visit with MD