CCANTER
Networker
i wasnt sure for this chronic rotator cuff tear repair whether I should use 23412 or 23420
Shoulder was insufflated with approximately 30 cc of fluid. Scope was inserted through a posterior portal and the shoulder was systematically checked. Anterior portal was made under direct visualization and a cannula was placed. Biceps was noted to be longitudinally torn and very irritated and this was then cut and the labrum was debrided. Attention was then turned the subacromial space which was cleaned out of any scar tissue. There was quite a bit of bleeding that was difficult to control at this time and took some time to get under control for visualization purposes.
Subacromial decompression and distal clavicle excision where then performed. The cuff was very difficult to find as it was both posterior and medial to the glenoid. We able to find cuff and pull it over and even with freeing it up were only able to get it to about midportion of the head. Then placed a total of 4 sutures for total of 8 passing sutures going in and out all coming up in a mattress fashion above and then were able to pull over best we could though there was still some uncovered area of the head anteriorly. This point we elected to utilize a dermal graft as an interposition between the cuff and the tuberosity. We then remove the scope and opened the lateral working portal sutures were then tied down to the dermal graft to tie the graft to the cuff and then placed over the graft into 2 more suture anchors to tie it all down to the tuberosity. We are able to get the posterior two thirds of the head covered that there is still no coverage of the front as this was too retracted and there was no cuff anteriorly to tie this to.
Incision was then made anteriorly and a biceps tenodesis was performed utilizing a fiber tack suture anchor.
Wounds were then closed with deep Vicryl and the deltoid via by 3-0 Vicryl subcutaneously and a running Monocryl stitch with Dermabond and sterile Mepilex dressings.
Shoulder was insufflated with approximately 30 cc of fluid. Scope was inserted through a posterior portal and the shoulder was systematically checked. Anterior portal was made under direct visualization and a cannula was placed. Biceps was noted to be longitudinally torn and very irritated and this was then cut and the labrum was debrided. Attention was then turned the subacromial space which was cleaned out of any scar tissue. There was quite a bit of bleeding that was difficult to control at this time and took some time to get under control for visualization purposes.
Subacromial decompression and distal clavicle excision where then performed. The cuff was very difficult to find as it was both posterior and medial to the glenoid. We able to find cuff and pull it over and even with freeing it up were only able to get it to about midportion of the head. Then placed a total of 4 sutures for total of 8 passing sutures going in and out all coming up in a mattress fashion above and then were able to pull over best we could though there was still some uncovered area of the head anteriorly. This point we elected to utilize a dermal graft as an interposition between the cuff and the tuberosity. We then remove the scope and opened the lateral working portal sutures were then tied down to the dermal graft to tie the graft to the cuff and then placed over the graft into 2 more suture anchors to tie it all down to the tuberosity. We are able to get the posterior two thirds of the head covered that there is still no coverage of the front as this was too retracted and there was no cuff anteriorly to tie this to.
Incision was then made anteriorly and a biceps tenodesis was performed utilizing a fiber tack suture anchor.
Wounds were then closed with deep Vicryl and the deltoid via by 3-0 Vicryl subcutaneously and a running Monocryl stitch with Dermabond and sterile Mepilex dressings.