amandapsps
Contributor
Excision of the trapezium, soft tissue interposition flexor carpi rasialis tendon.
Capsulodesis thumb MC joint
K-wire fixation, mitek anchor.
DESCRIPTION OF PROCEDURE: The patient was seen preoperatively. Her left upper limb was identified as the correct operative site, confirmed with the nursing and anesthesia staff and the patient's record. The patient had a left axillary block anesthesia. After the anesthesia was completed, the patient was brought to the operating room. Sterile prepping and draping of the left upper limb was performed. After completing prepping and draping, the limb was elevated, exsanguinated, and the tourniquet elevated to 250 mmHg.
Beginning on the left thumb, a curvilinear Wagner incision was performed. Soft tissue flaps were elevated. Care was taken to identify and protect the dorsal cutaneous radial sensory nerve and its branches. The thenar muscles were reflected off of the thumb metacarpal and the metacarpotrapezial joint. The flexor carpi radialis tendon was identified proximally at the wrist flexion crease. With the thenar muscles released off the thumb metacarpal, the joint capsule was divided. There was considerable heterotopic bone formation about the metacarpotrapezial joint. Using a rongeur and osteotome, the trapezium and heterotopic bone was removed. X-rays were obtained to confirm complete removal of the trapezium and heterotopic bone.
From the patient's left forearm, we harvested the entire flexor carpi radialis tendon through a proximal transverse incision 8 cm proximal to the wrist flexion crease. It was then brought distally, split in half. Half of the tendon was placed through a drill hole in the base of the thumb metacarpal to service a suspensionplasty, which was confirmed clinically at time of surgery. The two split portions of the flexor carpi radialis tendon were then rolled onto themselves, sutured in place, and then placed deep into the joint of the excised trapezium that is the thumb metacarpotrapezial joint with 4-0 Vicryl sutures. The joint capsule was then closed over this area with 4-0 Vicryl sutures.
Attention was then played to the MCP joint, where hyperextension deformity was present. The interval between the extensor pollicis longus tendon and the radial thenar muscles, abductor pollicis brevis, and opponens pollicis was divided. Partial reflection of the insertion of the abductor pollicis brevis was performed. The ulnar collateral ligament and joint capsule were identified proximally and elevated. A Mitek anchor was then placed in the distal portion of the thumb metacarpal volarly at the base of the metacarpal head. The Mitek anchor was inserted and used as a capsulodesis 3-0 Polydek suture to prevent hyperextension of the thumb metacarpophalangeal joint. The metacarpophalangeal joint was then pinned with a .035 K-wire to help maintain the correct position of capsulodesis, 25 degrees of flexion.
At this juncture, the tourniquet was deflated. Hemostasis was obtained with bipolar cautery. The joint capsule at the metacarpotrapezial joint was reinforced with 4-0 Vicryl sutures, the thenar muscles reattached to their insertion with 4-0 Vicryl sutures. Hemostasis obtained with bipolar cautery. Irrigation of the wounds were injected with 6 cc of 0.5% Marcaine for postoperative pain relief. Subcutaneous closure with 4-0 Vicryl, skin with 4-0 Prolene sutures distally and 4-0 Vicryl, and a subcutaneous suture proximally in the mid forearm. Steri-Strips were also applied and a silastic drain was inserted in the thenar incision. Wounds were then dressed with Xeroform, 4x4s, multiple fluffs, Sof-Rol, and a supportive plaster splint.
I am thinking 25310 25210 x2 and ???? any help would be GREAT!
Capsulodesis thumb MC joint
K-wire fixation, mitek anchor.
DESCRIPTION OF PROCEDURE: The patient was seen preoperatively. Her left upper limb was identified as the correct operative site, confirmed with the nursing and anesthesia staff and the patient's record. The patient had a left axillary block anesthesia. After the anesthesia was completed, the patient was brought to the operating room. Sterile prepping and draping of the left upper limb was performed. After completing prepping and draping, the limb was elevated, exsanguinated, and the tourniquet elevated to 250 mmHg.
Beginning on the left thumb, a curvilinear Wagner incision was performed. Soft tissue flaps were elevated. Care was taken to identify and protect the dorsal cutaneous radial sensory nerve and its branches. The thenar muscles were reflected off of the thumb metacarpal and the metacarpotrapezial joint. The flexor carpi radialis tendon was identified proximally at the wrist flexion crease. With the thenar muscles released off the thumb metacarpal, the joint capsule was divided. There was considerable heterotopic bone formation about the metacarpotrapezial joint. Using a rongeur and osteotome, the trapezium and heterotopic bone was removed. X-rays were obtained to confirm complete removal of the trapezium and heterotopic bone.
From the patient's left forearm, we harvested the entire flexor carpi radialis tendon through a proximal transverse incision 8 cm proximal to the wrist flexion crease. It was then brought distally, split in half. Half of the tendon was placed through a drill hole in the base of the thumb metacarpal to service a suspensionplasty, which was confirmed clinically at time of surgery. The two split portions of the flexor carpi radialis tendon were then rolled onto themselves, sutured in place, and then placed deep into the joint of the excised trapezium that is the thumb metacarpotrapezial joint with 4-0 Vicryl sutures. The joint capsule was then closed over this area with 4-0 Vicryl sutures.
Attention was then played to the MCP joint, where hyperextension deformity was present. The interval between the extensor pollicis longus tendon and the radial thenar muscles, abductor pollicis brevis, and opponens pollicis was divided. Partial reflection of the insertion of the abductor pollicis brevis was performed. The ulnar collateral ligament and joint capsule were identified proximally and elevated. A Mitek anchor was then placed in the distal portion of the thumb metacarpal volarly at the base of the metacarpal head. The Mitek anchor was inserted and used as a capsulodesis 3-0 Polydek suture to prevent hyperextension of the thumb metacarpophalangeal joint. The metacarpophalangeal joint was then pinned with a .035 K-wire to help maintain the correct position of capsulodesis, 25 degrees of flexion.
At this juncture, the tourniquet was deflated. Hemostasis was obtained with bipolar cautery. The joint capsule at the metacarpotrapezial joint was reinforced with 4-0 Vicryl sutures, the thenar muscles reattached to their insertion with 4-0 Vicryl sutures. Hemostasis obtained with bipolar cautery. Irrigation of the wounds were injected with 6 cc of 0.5% Marcaine for postoperative pain relief. Subcutaneous closure with 4-0 Vicryl, skin with 4-0 Prolene sutures distally and 4-0 Vicryl, and a subcutaneous suture proximally in the mid forearm. Steri-Strips were also applied and a silastic drain was inserted in the thenar incision. Wounds were then dressed with Xeroform, 4x4s, multiple fluffs, Sof-Rol, and a supportive plaster splint.
I am thinking 25310 25210 x2 and ???? any help would be GREAT!