DIAGNOSIS:
1. Right long finger mass.
2. Left long finger mass
POSTOP DIAGNOSIS:
Same.
PROCEDURE:
1. Excision Left long finger mass, deep (3mm diameter x2 ).
2. Excision Right long finger mass, deep ( 3 mm diameter).
3. Flap closure Right long finger ( 3:2 rhomboid)
SURGEON:
ASSISTANT:
(no orthopedic resident on site or service).
ANESTHESIA:
LMA.
TOURNIQUET TIME:
0 minutes.
BLOOD LOSS:
Minimal.
FLUIDS:
Per anesthesia record.
OPERATIVE FINDINGS: left long DIP GCs x 2- 3mm, penetrating Extensor tendon; RT 3mm volar/ulnar mass arising off NV bundle with dense skin adherence and soft tissue defect mild.
OPERATIVE SUMMARY IN DETAIL:
Following appropriate informed consent, patient identification, and operative limb, the patient was brought to the operating suite where smooth induction of LMA anesthesia was accomplished by Anesthesiology Service and She received broad-spectrum IV antibiotic prophylaxis. The Left upper extremity was prepped and draped in the usual sterile fashion. Time-out procedure performed. The limb was exsanguinated with an Esmarch bandage. A transveres incision over the Left long finger DIP was carried out over the palpable masses. Blunt dissection was carried down through the subcutaneous tissues. The mass was identified and meticulously dissected and mobilized It was a bilobed 3-4mm sized mass with clear fluid that was consistent with a GC. The mass was excised and sent to pathology. An oblique incision was carried out over the Right long finger mass and blunt dissection was performed to safely elevate it from the ulnar NVb just distal to the volar DIP. The NVB was identified and retracted and the mass delivered from the wound along with an ellipse of densely adherent skin. It had a firm consistency. There was no undue bleeding. Hemostasis performed using electrocautery. A 2 cm 3:2 volar rhomboid flap was then produced to advance and close the excision site in order to cover the NVB.The wounds were reapproximated with nonabsorbable sutures and infiltrated with 0.5% Marcaine for perioperative pain relief. Sterile nonadherent dressing was applied. She was extubated and transported to the recovery area in stable condition. There were no intraoperative complications.
BRIEF CLINICAL HISTORY
1 - left long finger mass, 2 - right long finger mass.
GROSS:
Specimen #1 labeled mass left long finger are three tan fibrous
fragments ranging from 0.2 to 0.3 cm. Entirely submitted in 1A.
Specimen #2 labeled mass right long finger is a 0.8 x 0.3 x 0.3 cm
unoriented ellipse of tan-gray skin with a central 0.2 cm papule.
Sectioned and entirely submitted in 2A.
JAH/sc/COC
MICROSCOPIC DIAGNOSIS:
Mass, left long finger, excision: Fibromembranous tissue with features
suggestive of digital
mucous cyst.
Mass, right long finger, excision: Benign skin with underlying dermal
scarring. No evidence
of malignancy identified.
1. Right long finger mass.
2. Left long finger mass
POSTOP DIAGNOSIS:
Same.
PROCEDURE:
1. Excision Left long finger mass, deep (3mm diameter x2 ).
2. Excision Right long finger mass, deep ( 3 mm diameter).
3. Flap closure Right long finger ( 3:2 rhomboid)
SURGEON:
ASSISTANT:
(no orthopedic resident on site or service).
ANESTHESIA:
LMA.
TOURNIQUET TIME:
0 minutes.
BLOOD LOSS:
Minimal.
FLUIDS:
Per anesthesia record.
OPERATIVE FINDINGS: left long DIP GCs x 2- 3mm, penetrating Extensor tendon; RT 3mm volar/ulnar mass arising off NV bundle with dense skin adherence and soft tissue defect mild.
OPERATIVE SUMMARY IN DETAIL:
Following appropriate informed consent, patient identification, and operative limb, the patient was brought to the operating suite where smooth induction of LMA anesthesia was accomplished by Anesthesiology Service and She received broad-spectrum IV antibiotic prophylaxis. The Left upper extremity was prepped and draped in the usual sterile fashion. Time-out procedure performed. The limb was exsanguinated with an Esmarch bandage. A transveres incision over the Left long finger DIP was carried out over the palpable masses. Blunt dissection was carried down through the subcutaneous tissues. The mass was identified and meticulously dissected and mobilized It was a bilobed 3-4mm sized mass with clear fluid that was consistent with a GC. The mass was excised and sent to pathology. An oblique incision was carried out over the Right long finger mass and blunt dissection was performed to safely elevate it from the ulnar NVb just distal to the volar DIP. The NVB was identified and retracted and the mass delivered from the wound along with an ellipse of densely adherent skin. It had a firm consistency. There was no undue bleeding. Hemostasis performed using electrocautery. A 2 cm 3:2 volar rhomboid flap was then produced to advance and close the excision site in order to cover the NVB.The wounds were reapproximated with nonabsorbable sutures and infiltrated with 0.5% Marcaine for perioperative pain relief. Sterile nonadherent dressing was applied. She was extubated and transported to the recovery area in stable condition. There were no intraoperative complications.
BRIEF CLINICAL HISTORY
1 - left long finger mass, 2 - right long finger mass.
GROSS:
Specimen #1 labeled mass left long finger are three tan fibrous
fragments ranging from 0.2 to 0.3 cm. Entirely submitted in 1A.
Specimen #2 labeled mass right long finger is a 0.8 x 0.3 x 0.3 cm
unoriented ellipse of tan-gray skin with a central 0.2 cm papule.
Sectioned and entirely submitted in 2A.
JAH/sc/COC
MICROSCOPIC DIAGNOSIS:
Mass, left long finger, excision: Fibromembranous tissue with features
suggestive of digital
mucous cyst.
Mass, right long finger, excision: Benign skin with underlying dermal
scarring. No evidence
of malignancy identified.