# Hand Coding



## risnerclan (Jan 28, 2010)

I need your help....I have attached the op note for you too look at and give your suggestions!

*Preoperative diagnosis -
Tendon adhesions and loss of extension of the left index finger.

Postoperative diagnosis -
Tendon adhesions and loss of extension of the left index finger.

Procedures performed -
1.  Tenolysis of the EIP and EDC tendons the left index finger.
2.  Tendon transfer of the EDC of the index finger to the EDC of the long
    finger.
3.  Tendon transfer of the EIP tendon of the left index finger to the EDC of
    the left long finger.
4.  Wrist block.
5.  Volar plaster splint.

Preoperative note -
Left index finger extension lag from tendon adhesions after a previous injury
to extensor tendon zone 8 and 9 repairs with physical therapy, unable to free
up and scar treatment unable to free up the tendon adhesions effect in need of
tendon transfer due to affecting the functionality of the patient's hand.  She
is unable to extend her finger actively, passively.  Has excellent passive
range of motion and has no signs of arthritic changes, just has no active
extension and this affects her ability to grip or punch in need of tendon
transfer.  The procedure was explained to the patient and her mom.  They
verbalize understanding. Signed consent was placed in the chart and proceeded
to the OR.

Procedure -
The patient was taken to the OR and after general care anesthesia was prepped
and draped in a sterile fashion in the supine position with the left arm out
on an arm board.  A zigzag incision was made on the dorsum of the hands
centered over the left index as well a along the finger.  Careful sharp and
blunt dissection was carried out to expose the IP tendon as well as the EDC
tendon.   Once these were identified, we again confirmed the adhesions and a
tenolysis was performed of each of these tendons to free up.  We then resected
the tendons at the level the wrist approximately zone 7 and brought the tendon
transfer over and the using the Pulvertaft weave x3 we were able to transfer
the EDC of the index finger to the EDC of the long and the EIP tendon to the
EDC of the long as well.  Once we completed these transfers and repairs with
multiple Supramid sutures placed through to hold a good amount of tension with
the fingers and wrist in slight extension, we then had positive tenodesis
effect with excellent passive range of motion as well as full flexion without
interference of any of the flexion of any of the fingers and again the
tenodesis effect was intact for the index, long, ring and small fingers.  The
wound was copiously irrigated, blot dried and removed, and then closure was
performed.  Local anesthetic was injected throughout the wound.  Sterile
dressings were placed.  All instrument, needle and sponge counts were reported
as correct.  A plaster splint was made and placed with the wrist in slight
extension and the fingers in full extension.  The patient was transferred to
the PACU in stable condition.

Postoperatively, she will follow up 2 weeks for DC of her dressing, placement
into a splint, and started on physical therapy.  We did discuss with the
patient as well as the mom both preoperatively and postoperatively about her
control of her blood sugars as we need to increase risk of infection as well
as scarring and less than optimal outcome.  They verbalized understanding and
will do their best to maintain good control of her blood sugars, will call if
any questions or concerns.  Again all was explained to the patient and her
mom.  They verbalized understanding and wished to proceed with this plan.*

let me know what you think!

Carol


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