Procedure Date: 4/14/2014
Post Operative Note
Department of Plastic Surgery
Procedure Date: 4/14/2014
Preoperative Diagnosi: soft tissue mass back x2, soft tissue mass -bilateral feet (every toe) soft tissue mass left long and thumb nail with nail deformity
Postoperative Diagnosis: same
Procedure Performed: Excision of soft tissue mass of the back x2: 4cm and 6 cm, removal of left index and thumb nail with excision of soft tissue mass 1 cm. Excision of soft tissue masses from bilateral feet total 10cm
Right small: 1.5cm
Right ring: 1cm
Right long: 0.5cm
Right indez: 0.5cm.
Right great toe: 1.25cm
Left small: 1.5cm
Left ring: .25cm
Left long: 0.5cm
Left index: 1.5 cm
Left great toe: 1cm
Anesthesia:General
Antibiotics:Ancef 2 gm IV
Complications: none
IV Fluids: 1000ml
Estimated Blood Loss: Minimal
Specimens: soft tissue mass back x2, soft tissue mass right and left feet. Soft tissue mass LUE, left index and thumb nails.
Condition of Patient:
The patient was transferred in stable condition.
Summary:
The patient was transferred to the OR and placed into a supine position. General LMA anesthesia was induced. The patient was prepped and draped. A formal timeout procedure was then performed. Once all members of the operative team were in agreement the procedure commenced.
Starting with the LUE the thumb nail was elevated with a freer elevator and the nail was removed. A soft tissue mass was noted on the ulnar aspect, it was bluntly dissected and removed. Electrocautery was used to obtain hemostasis. A splint was placed into the proximal nail fold. The index nail was then elevated and removed. Again a soft tissue mass was noted on the ulnar aspect. A 1 cm incision was made in the ulnar aspect of the nail fold to facilitate exposure. The mass was dissected and removed. Electrocautery was used to obtain hemostasis. A splint was placed into the proximal nail fold. Xeroform was applied to both nail beds and kerlix wraps were applied for dressing.
The feet were addressed next. Starting the left foot, soft tissue masses were noted superficial on each toe. Ease lesion was dissected with a freer elevator and transected at the base. Electrocautery was used to obtain hemostasis. This process was repeated for each digit. The right foot was then addressed. Again, soft tissue masses were noted superficial on each toe. Ease lesion was dissected with a freer elevator and transected at the base. Electrocautery was used to obtain hemostasis. This process was repeated for each digit. Xeroform was applied to each digit and circumferentially placed kerlix were used for dressing.
The patient was then placed into a right lateral decubitus position. He was then prepped and draped. Beginning with the superior lesion a 4 cm incision was made of the apex of the lesion. The cystic lesion was identified and then circumferentially dissected from the subcutaneous tissues. The lesion was removed and the wound was irrigated with normal saline. Hemostasis was noted. THe wound was closed with interrupted deep dermal 3-0 polysorb followed by a running 4-0 polysorb subcuticular stitch. The inferior lesion was then addressed. An 8 cm incision was made over the apex of the lesion.The cystic lesion was identified and then circumferentially dissected from the subcutaneous tissues. The lesion was removed and the wound was irrigated with normal saline. Hemostasis was noted. The wound was closed with interrupted deep dermal 3-0 polysorb followed by interrupted 4-0 surgipro. Dressing sponges were used for dressing.
Patient was allowed to awaken from anesthesia and the LMA device was removed. He was then transferred to the PACU in stable condition. The patient tolerated the procedure well, no complications. Count were correct x
Path report:
BRIEF CLINICAL HISTORY
1 - left hand thumbnail,. 2 0 left hand index nail,3 - soft tissue mass,
left index finger, 4 - right foot toe masses, 5 - left foot toe masses,
6 - soft tissue mass, back superior, 7 - sebaceous cyst, inferior back.
History of onychomycosis and tuberous sclerosis.
GROSS:
Specimen #1 labeled thumbnail left hand is a 1.1 x 2.0 x 1.2 cm
tan-brown thick nail clipping. Entirely submitted in 1A following
softening.
Specimen #2 labeled index nail left hand is a 1.7 x 1.3 x 0.6 cm tan
thick nail clipping. Entirely submitted in 2A following softening.
Specimen #3 labeled soft tissue mass left index finger are two pale tan
to tan fragments ranging from 0.6 x 0.5 x 0.3 to 0.9 x 0.5 x 0.4 cm of
rubbery fragments. Sectioned and entirely submitted in 3A.
Specimen #4 labeled right foot toe masses are six pale tan rubbery
fragments ranging from 0.5 x 0.4 x 0.3 to 1.6 x 1.0 x 0.9 cm. Sectioned
and entirely submitted in 4A-4B.
Specimen #5 labeled left toe masses are six pale tan to brown fragments
ranging from 0.4 x 0.3 x 0.3 to 1.3 x 1.0 x 0.8 cm of a rubbery firm
fragment. Sectioned and entirely submitted in 5A-5B.
Specimen #6 labeled soft tissue mass back superior is a 2.3 x 0.9 x 1.5
cm ellipse of pale tan skin with a central 1.5 x 0.3 cm of a tan eroded
area. While sectioning the specimen it is cyst measuring 1.5 x 0.5 x
0.9 cm containing tan-white pasty substance. Sectioned and
representatively submitted in 6A.
Specimen #7 labeled sebaceous cyst inferior back is a 4.0 x 3.5 x 2.3 cm
tan-blue and yellow cyst containing tan-white pasty substance.
Sectioned and representatively submitted in 7A.
MA/rsp/FO
MICROSCOPIC DIAGNOSIS:
Thumbnail, left hand, clipping: Fragments of thicken nail plate with
focal bacterial
colonies, parakeratosis and focal serum crust; negative for
fungal organisms by GMS stain.
Index nail, left hand, clipping: Fragments of thicken nail plate with
focal bacterial
colonies, parakeratosis and focal serum crust; negative for
fungal organisms
by GMS stain.
Skin and soft tissue, mass of left index finger, submitted: Polypoid
fragments of
acral skin with ectatic vessels and dense fibrosis consistent
with fibroma.
Focal calcinosis cutis.
Skin and soft tissue, right foot toe masses, submitted: Polypoid
fragments of
acral skin with ectatic vessels and dense fibrosis consistent
with fibroma.
Skin and soft tissue, left foot toe masses, submitted: Polypoid
fragments of
acral skin with ectatic vessels and dense fibrosis consistent
with fibroma.
Skin and soft tissue, mass of superior back, submitted: Epidermal cyst.
Skin and soft tissue, inferior back, submitted: Epidermal cyst
Post Operative Note
Department of Plastic Surgery
Procedure Date: 4/14/2014
Preoperative Diagnosi: soft tissue mass back x2, soft tissue mass -bilateral feet (every toe) soft tissue mass left long and thumb nail with nail deformity
Postoperative Diagnosis: same
Procedure Performed: Excision of soft tissue mass of the back x2: 4cm and 6 cm, removal of left index and thumb nail with excision of soft tissue mass 1 cm. Excision of soft tissue masses from bilateral feet total 10cm
Right small: 1.5cm
Right ring: 1cm
Right long: 0.5cm
Right indez: 0.5cm.
Right great toe: 1.25cm
Left small: 1.5cm
Left ring: .25cm
Left long: 0.5cm
Left index: 1.5 cm
Left great toe: 1cm
Anesthesia:General
Antibiotics:Ancef 2 gm IV
Complications: none
IV Fluids: 1000ml
Estimated Blood Loss: Minimal
Specimens: soft tissue mass back x2, soft tissue mass right and left feet. Soft tissue mass LUE, left index and thumb nails.
Condition of Patient:
The patient was transferred in stable condition.
Summary:
The patient was transferred to the OR and placed into a supine position. General LMA anesthesia was induced. The patient was prepped and draped. A formal timeout procedure was then performed. Once all members of the operative team were in agreement the procedure commenced.
Starting with the LUE the thumb nail was elevated with a freer elevator and the nail was removed. A soft tissue mass was noted on the ulnar aspect, it was bluntly dissected and removed. Electrocautery was used to obtain hemostasis. A splint was placed into the proximal nail fold. The index nail was then elevated and removed. Again a soft tissue mass was noted on the ulnar aspect. A 1 cm incision was made in the ulnar aspect of the nail fold to facilitate exposure. The mass was dissected and removed. Electrocautery was used to obtain hemostasis. A splint was placed into the proximal nail fold. Xeroform was applied to both nail beds and kerlix wraps were applied for dressing.
The feet were addressed next. Starting the left foot, soft tissue masses were noted superficial on each toe. Ease lesion was dissected with a freer elevator and transected at the base. Electrocautery was used to obtain hemostasis. This process was repeated for each digit. The right foot was then addressed. Again, soft tissue masses were noted superficial on each toe. Ease lesion was dissected with a freer elevator and transected at the base. Electrocautery was used to obtain hemostasis. This process was repeated for each digit. Xeroform was applied to each digit and circumferentially placed kerlix were used for dressing.
The patient was then placed into a right lateral decubitus position. He was then prepped and draped. Beginning with the superior lesion a 4 cm incision was made of the apex of the lesion. The cystic lesion was identified and then circumferentially dissected from the subcutaneous tissues. The lesion was removed and the wound was irrigated with normal saline. Hemostasis was noted. THe wound was closed with interrupted deep dermal 3-0 polysorb followed by a running 4-0 polysorb subcuticular stitch. The inferior lesion was then addressed. An 8 cm incision was made over the apex of the lesion.The cystic lesion was identified and then circumferentially dissected from the subcutaneous tissues. The lesion was removed and the wound was irrigated with normal saline. Hemostasis was noted. The wound was closed with interrupted deep dermal 3-0 polysorb followed by interrupted 4-0 surgipro. Dressing sponges were used for dressing.
Patient was allowed to awaken from anesthesia and the LMA device was removed. He was then transferred to the PACU in stable condition. The patient tolerated the procedure well, no complications. Count were correct x
Path report:
BRIEF CLINICAL HISTORY
1 - left hand thumbnail,. 2 0 left hand index nail,3 - soft tissue mass,
left index finger, 4 - right foot toe masses, 5 - left foot toe masses,
6 - soft tissue mass, back superior, 7 - sebaceous cyst, inferior back.
History of onychomycosis and tuberous sclerosis.
GROSS:
Specimen #1 labeled thumbnail left hand is a 1.1 x 2.0 x 1.2 cm
tan-brown thick nail clipping. Entirely submitted in 1A following
softening.
Specimen #2 labeled index nail left hand is a 1.7 x 1.3 x 0.6 cm tan
thick nail clipping. Entirely submitted in 2A following softening.
Specimen #3 labeled soft tissue mass left index finger are two pale tan
to tan fragments ranging from 0.6 x 0.5 x 0.3 to 0.9 x 0.5 x 0.4 cm of
rubbery fragments. Sectioned and entirely submitted in 3A.
Specimen #4 labeled right foot toe masses are six pale tan rubbery
fragments ranging from 0.5 x 0.4 x 0.3 to 1.6 x 1.0 x 0.9 cm. Sectioned
and entirely submitted in 4A-4B.
Specimen #5 labeled left toe masses are six pale tan to brown fragments
ranging from 0.4 x 0.3 x 0.3 to 1.3 x 1.0 x 0.8 cm of a rubbery firm
fragment. Sectioned and entirely submitted in 5A-5B.
Specimen #6 labeled soft tissue mass back superior is a 2.3 x 0.9 x 1.5
cm ellipse of pale tan skin with a central 1.5 x 0.3 cm of a tan eroded
area. While sectioning the specimen it is cyst measuring 1.5 x 0.5 x
0.9 cm containing tan-white pasty substance. Sectioned and
representatively submitted in 6A.
Specimen #7 labeled sebaceous cyst inferior back is a 4.0 x 3.5 x 2.3 cm
tan-blue and yellow cyst containing tan-white pasty substance.
Sectioned and representatively submitted in 7A.
MA/rsp/FO
MICROSCOPIC DIAGNOSIS:
Thumbnail, left hand, clipping: Fragments of thicken nail plate with
focal bacterial
colonies, parakeratosis and focal serum crust; negative for
fungal organisms by GMS stain.
Index nail, left hand, clipping: Fragments of thicken nail plate with
focal bacterial
colonies, parakeratosis and focal serum crust; negative for
fungal organisms
by GMS stain.
Skin and soft tissue, mass of left index finger, submitted: Polypoid
fragments of
acral skin with ectatic vessels and dense fibrosis consistent
with fibroma.
Focal calcinosis cutis.
Skin and soft tissue, right foot toe masses, submitted: Polypoid
fragments of
acral skin with ectatic vessels and dense fibrosis consistent
with fibroma.
Skin and soft tissue, left foot toe masses, submitted: Polypoid
fragments of
acral skin with ectatic vessels and dense fibrosis consistent
with fibroma.
Skin and soft tissue, mass of superior back, submitted: Epidermal cyst.
Skin and soft tissue, inferior back, submitted: Epidermal cyst