# complex laceration help



## marie26 (Mar 6, 2013)

*Help Please: complex laceration help*

I am including the operative report.. 
*HELP PLEASE*!!!!!!!!!!! I think I have my diag and procedures codes but I do want to see what others would do for this. I am not real comfortable with this one. *HELP* ...This is such a tramatic laceration... Thanks in advance for your help..

Postoperative Diagnosis
1. Left ulnar nerve laceration
2. Complex Laceration, Left volar forearm greater than 30 cm.
3. Left flexor carpi radialis partial tenon laceration at the wrist
4. Flexor carpi ulnaris and flexor digitorum superficialis muscle belly laceration
5. Left ulnar artery laceration
6. Left palmaris longus laceration

Procedure
1. Left ulnar nerve repair in the proximal forearm
2. Left flexor carpi radialis tendon repair at the wrist
3. Left forearm volar fasciotomy
4. Debridement and closure of left volar forearm laceration greater than 30 cm.
5. Flexor carpi ulnaris and flexor digitorum superficialis muscle belly repair
6. Left ulnar arter ligation

Procedure detail:
We began by debriding the wound edges with a 15 blade and tenotomy scissors. Total laceration was greater than 30 cm. We also irrigated and debrided this laceration at the base of her thumb 1st web space. This was closed with 3-0 nylon. We then turned our attention to the flexor carpi radialis tendon at the wrist. It was found to be partially lacerated, but we elected to leave that lacerated and not fix that. We then worked proximally, found that she had laceration of her FDS and FUC muscle bellies. We found the ulnar artery and nerve. We ligated the ulnar artery both proximally and distally with 2-0 silk ties. We then performed a volar fasciotomy of what was left of the superficial and the deep compartments. We then reapproximated the ulnar nerve and repaired it with epineural stitch of 6-0 nylon. It was about 6 or 7 interrupted sutures. It was repaired minimal tension. We then let the tourniquet down, made sure we had good hemostasis, and we repaired the FCU and FDS muscle bellies with O Vicryl as best we could. The skin was then closed with 3-0 nylon.


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