trose45116
Expert
Is all this included in the biceps repair? it sounds like it is but what are your thoughts? thanks
procedure #3 and #4
PREOPERATIVE DIAGNOSIS: Right distal biceps rupture, status post wound infection with plastic surgery closure.
POSTOPERATIVE DIAGNOSIS: Right distal biceps rupture, status post wound infection with plastic surgery closure.
PROCEDURES PERFORMED:
1. Right distal biceps repair with Achilles allograft augmentation.
2. Right biceps muscle lengthening.
3. Right soft tissue mobilization, wound, 10 cm x 4 cm.
4. Fascial sling reconstruction.
ANESTHESIA: GET.
COMPLICATIONS: None noted.
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS FOR THE PROCEDURE: The patient initially injured himself overseas while he was serving as a medic. He had his definitive surgery in Dubai. He subsequently returned to the States and had an infection. We explored the wound and he had essentially a distal biceps rupture. The plan was to at some point reconstruct his distal biceps. He had seen Infectious Disease. He did get clearance from this. It has been over two months since Plastic Surgery closed the wound. I did speak with Plastic Surgery, Dr. Admire, and he was comfortable with us performing surgery at this point. I did describe to Kyle the higher risk of infection given previous issues. He was definitely interested in distal biceps repair. He understood the risk of infection. Risks and benefits of surgery were described in detail including but not limited to infection, bleeding, damage to vessels and nerves, continued pain, and possible repeat surgery. All questions were answered.
PROCEDURE AND FINDINGS: The patient was taken to the Operating Room after appropriate site was marked and consent was obtained. She was transferred to the OR table, and anesthesia was successfully induced. The hand table was utilized. The right upper extremity was prepped and draped in usual sterile fashion. A time-out was performed. Antibiotics were given prior to skin incision. We opened his previous wound. He obviously had significant amount of adhesions and we did a significant amount of soft tissue mobilization, essentially in entire wound, 10 cm x 4 cm.
We were able to identify lateral antebrachial cutaneous. This was protected. We then dissected out the muscle belly. We had good length on the biceps. There was a very minimal biceps stump. We then dissected down to the radial tuberosity. There were vessels about the leash of Henry that we did have to tie off. We did use C-arm throughout the case and the radial tuberosity was identified. We were pleased with this. We then turned out attention towards the Achilles. We fashioned the Achilles where we could drill 7.5. We used FiberLoop and the tendinous portion of the Achilles was whipstitched. We stitched up easily to a size 8 and tied to a size 7. We did place the pin in the radial tuberosity. We were pleased with the position. We did check this under C-arm. We then drilled the 7.5. We used the button and this was flipped over the far cortex. We did check this under fluoro. We then placed the PEEK screw after the tendon was upheld in the tunnel and whipstitched. The PEEK screw was then placed. We were very pleased with this. We had two fascial limbs. We did tunnel the biceps under so we would not get a bowstringing-type effect. For initial fascial sling, I was distal and we did do fascial sling a bit more proximal to again decrease the bowstringing. We then had Fiberwire and pulled down on the biceps muscle belly. We then placed approximately 20 simple sutures to connect the biceps to a portion of the Achilles. Again, we were pleased with this. We did this with the arm in approximately 25 degrees of flexion. Again, we were pleased with this. We did not feel that it was over tensioned or under tensioned. The wound was thoroughly irrigated. Deep tissue was closed with 0 Vicryl, subcutaneous tissue was closed with 2-0 Monocryl, and skin was closed with 3-0 nylon in a simple stitch fashion. Xeroform, 4 x 4’s, ABDs, Ace wrap, and a posterior splint were applied. The patient was taken to Recovery Room in stable condition. There were no apparent complications.
procedure #3 and #4
PREOPERATIVE DIAGNOSIS: Right distal biceps rupture, status post wound infection with plastic surgery closure.
POSTOPERATIVE DIAGNOSIS: Right distal biceps rupture, status post wound infection with plastic surgery closure.
PROCEDURES PERFORMED:
1. Right distal biceps repair with Achilles allograft augmentation.
2. Right biceps muscle lengthening.
3. Right soft tissue mobilization, wound, 10 cm x 4 cm.
4. Fascial sling reconstruction.
ANESTHESIA: GET.
COMPLICATIONS: None noted.
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS FOR THE PROCEDURE: The patient initially injured himself overseas while he was serving as a medic. He had his definitive surgery in Dubai. He subsequently returned to the States and had an infection. We explored the wound and he had essentially a distal biceps rupture. The plan was to at some point reconstruct his distal biceps. He had seen Infectious Disease. He did get clearance from this. It has been over two months since Plastic Surgery closed the wound. I did speak with Plastic Surgery, Dr. Admire, and he was comfortable with us performing surgery at this point. I did describe to Kyle the higher risk of infection given previous issues. He was definitely interested in distal biceps repair. He understood the risk of infection. Risks and benefits of surgery were described in detail including but not limited to infection, bleeding, damage to vessels and nerves, continued pain, and possible repeat surgery. All questions were answered.
PROCEDURE AND FINDINGS: The patient was taken to the Operating Room after appropriate site was marked and consent was obtained. She was transferred to the OR table, and anesthesia was successfully induced. The hand table was utilized. The right upper extremity was prepped and draped in usual sterile fashion. A time-out was performed. Antibiotics were given prior to skin incision. We opened his previous wound. He obviously had significant amount of adhesions and we did a significant amount of soft tissue mobilization, essentially in entire wound, 10 cm x 4 cm.
We were able to identify lateral antebrachial cutaneous. This was protected. We then dissected out the muscle belly. We had good length on the biceps. There was a very minimal biceps stump. We then dissected down to the radial tuberosity. There were vessels about the leash of Henry that we did have to tie off. We did use C-arm throughout the case and the radial tuberosity was identified. We were pleased with this. We then turned out attention towards the Achilles. We fashioned the Achilles where we could drill 7.5. We used FiberLoop and the tendinous portion of the Achilles was whipstitched. We stitched up easily to a size 8 and tied to a size 7. We did place the pin in the radial tuberosity. We were pleased with the position. We did check this under C-arm. We then drilled the 7.5. We used the button and this was flipped over the far cortex. We did check this under fluoro. We then placed the PEEK screw after the tendon was upheld in the tunnel and whipstitched. The PEEK screw was then placed. We were very pleased with this. We had two fascial limbs. We did tunnel the biceps under so we would not get a bowstringing-type effect. For initial fascial sling, I was distal and we did do fascial sling a bit more proximal to again decrease the bowstringing. We then had Fiberwire and pulled down on the biceps muscle belly. We then placed approximately 20 simple sutures to connect the biceps to a portion of the Achilles. Again, we were pleased with this. We did this with the arm in approximately 25 degrees of flexion. Again, we were pleased with this. We did not feel that it was over tensioned or under tensioned. The wound was thoroughly irrigated. Deep tissue was closed with 0 Vicryl, subcutaneous tissue was closed with 2-0 Monocryl, and skin was closed with 3-0 nylon in a simple stitch fashion. Xeroform, 4 x 4’s, ABDs, Ace wrap, and a posterior splint were applied. The patient was taken to Recovery Room in stable condition. There were no apparent complications.