trose45116
Expert
PREOPERATIVE DIAGNOSIS: Status post right antecubital vascular injury with biceps tendon repair, with postoperative infection.
POSTOPERATIVE DIAGNOSES:
1. Right wound infection.
2. Right biceps tendon repair failure.
PROCEDURES PERFORMED: 1. Right wound I&D, 7 x 2 cm.
2. Right wound hardware removal.
3. Right wound biceps debridement.
ANESTHESIA: GET.
COMPLICATIONS: None noted.
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS: The patient comes in with chief complaint of right elbow pain. He did have a significant history and was injured in Baghdad. He cut his antecubital fossa with some glass. He had emergency surgery in Baghdad. It sounds like he had a vascular injury and they were unable to stop the bleeding. He was subsequently transferred to Dubai. His bleeding was stopped; however, they did have to transect his biceps tendon to find the bleeding. He came into the office with draining wound. I saw him yesterday. He was quite uncomfortable. I did recommend wound exploration and also to evaluate the biceps tendon.
OPERATIVE PROCEDURE: The patient was taken to the operating room, after appropriate side was marked and consent obtained. The patient was transferred to OR table, and anesthesia was successfully induced. Hand table was utilized. Right upper extremity was prepped and draped in the usual sterile fashion. Timeout was performed. Antibiotics were given prior to skin incision. I had a curvilinear incision approximately 7 cm, initially going up the forearm and then going in the antecubital fossa and then back vertical up to brachium. This was opened in its entirety. He did have serous drainage. There was no obvious purulent drainage. We did take cultures. We did dissect down. Lateral antebrachial cutaneous tissue was protected. There was abundant amount of scar tissue. There were sutures about the biceps tendon. The biceps tendon was not intact. We did remove this hardware. We also debrided the biceps tendon. We were able to identify the boundaries of the biceps anterior, inferior, medial and lateral. This was mobile. We dissected down and we did find the remnant of the biceps tendon through the radial tuberosity. There was no purulent drainage in this area.
We made a small nick in the fascia about the flexor pronator, and there was no evidence of purulence. We then debrided this with a 1000 cc of fluid. I did not want to repair the biceps in the setting of possible infection. We will plan to do a delayed reconstruction some point in the next two weeks or so. The wound was thoroughly irrigated. Deep tissue was closed with 0 Vicryl, and the skin was closed with 3-0 nylon in a simple stitch fashion loosely. We did pack the wound with 1/2-inch iodoform gauze. Xeroform, 4 x 4?s, ABDs, and Ace wrap were applied. The patient was taken to the recovery room in stable condition. There were no apparent complications.
POSTOPERATIVE DIAGNOSES:
1. Right wound infection.
2. Right biceps tendon repair failure.
PROCEDURES PERFORMED: 1. Right wound I&D, 7 x 2 cm.
2. Right wound hardware removal.
3. Right wound biceps debridement.
ANESTHESIA: GET.
COMPLICATIONS: None noted.
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS: The patient comes in with chief complaint of right elbow pain. He did have a significant history and was injured in Baghdad. He cut his antecubital fossa with some glass. He had emergency surgery in Baghdad. It sounds like he had a vascular injury and they were unable to stop the bleeding. He was subsequently transferred to Dubai. His bleeding was stopped; however, they did have to transect his biceps tendon to find the bleeding. He came into the office with draining wound. I saw him yesterday. He was quite uncomfortable. I did recommend wound exploration and also to evaluate the biceps tendon.
OPERATIVE PROCEDURE: The patient was taken to the operating room, after appropriate side was marked and consent obtained. The patient was transferred to OR table, and anesthesia was successfully induced. Hand table was utilized. Right upper extremity was prepped and draped in the usual sterile fashion. Timeout was performed. Antibiotics were given prior to skin incision. I had a curvilinear incision approximately 7 cm, initially going up the forearm and then going in the antecubital fossa and then back vertical up to brachium. This was opened in its entirety. He did have serous drainage. There was no obvious purulent drainage. We did take cultures. We did dissect down. Lateral antebrachial cutaneous tissue was protected. There was abundant amount of scar tissue. There were sutures about the biceps tendon. The biceps tendon was not intact. We did remove this hardware. We also debrided the biceps tendon. We were able to identify the boundaries of the biceps anterior, inferior, medial and lateral. This was mobile. We dissected down and we did find the remnant of the biceps tendon through the radial tuberosity. There was no purulent drainage in this area.
We made a small nick in the fascia about the flexor pronator, and there was no evidence of purulence. We then debrided this with a 1000 cc of fluid. I did not want to repair the biceps in the setting of possible infection. We will plan to do a delayed reconstruction some point in the next two weeks or so. The wound was thoroughly irrigated. Deep tissue was closed with 0 Vicryl, and the skin was closed with 3-0 nylon in a simple stitch fashion loosely. We did pack the wound with 1/2-inch iodoform gauze. Xeroform, 4 x 4?s, ABDs, and Ace wrap were applied. The patient was taken to the recovery room in stable condition. There were no apparent complications.