PREOPERATIVE DIAGNOSIS(ES):
1. Chronic wrist joint infection with osteomyelitis.
2. Diabetes.
POSTOPERATIVE DIAGNOSIS(ES): The same
PROCEDURE PERFORMED:
1. Right wrist irrigation and debridement with excisional debridement past the level of the fascia.
2. Extensive debridement of extensor tenosynovium as well as the joint capsule.
3. Decompression of capitate.
ANESTHESIA: General.
ANTIBIOTICS: Ancef after cultures were obtained.
PREP: CholraPrep.
TOTAL TOURNIQUET TIME: 49 minutes.
INDICATION FOR PROCEDURE: Patient is a 51-year-old male who arrived at my office yesterday due to chronic wrist pain of three months duration. He has seen multiple providers for it and has been prescribed steroids. He went to an outside hospital on February 11 where an aspirate was obtained. There were no crystals in aspirate. Cultures did grow Serratia marcescens. However, he only received one dose of IV antibiotics with continued pain. He had an MRI showing destructive changes seen throughout his carpal bones as well as extensive inflammation. He had elevated inflammatory markers. I admitted him that night with intention on performing incision and drainage the following morning due to the chronicity of his condition. He did understand that there was already destructive changes throughout his carpal bones and that the goal of surgery was to eradicate the infection, but he would likely need further procedures down the future secondary to the destruction of his wrist joint. Risks and benefits of the procedure including but not limited to infection, bleeding, injury to adjacent nerves, vessels, tendons, continued pain and weakness, need for further procedures, inability to eradicate infection was discussed. He understood the risks and benefits of the procedure and elected to proceed.
DESCRIPTION OF PROCEDURE: Patient was placed supine on the operating room table and all bony prominences were well-padded. He was prepped and draped in normal sterile fashion. Surgical time-out was performed with two patient identifiers confirming correct laterality and procedure to be performed. The limb was elevated. Tourniquet was inflated. A longitudinal incision was made over the dorsum of the wrist joint. Crossing veins were cauterized. The extensor retinaculum was opened up for the distal two-thirds. Extensive hemorrhagic synovium over the extensor tendons was identified and sharply debrided. The wrist joint itself was very boggy and inflamed. A fresh blade was used to incise to the wrist joint. There was some purulent material expressed from this. Multiple cultures were obtained of the synovium of the extensor tendons, the joint capsule itself as well as culture swabs of the wrist joint itself. Fluoroscopy was used to confirm level of the capitate and a 2 millimeter drill was used to drill on the dorsal aspect to decompress that area as there were cystic changes and fluid seen within the MRI. 6 liters of gravity irrigation was performed throughout the wrist joint, as well as extensor synovium. A deep drain was placed into the joint capsule itself and it was sutured to the skin. The extensor retinaculum was closed with 4-0 PDS. The skin was closed with nylon suture. Xeroform, 4 X 4, cast padding as well as an Ace was placed as a dressing. He was placed into a neutral splint.
I was attending of record and all counts were correct.
POSTOPERATIVE PLAN: Infectious disease will be consulted for assistance with antibiotic management.
Any and all help is appreciated.
1. Chronic wrist joint infection with osteomyelitis.
2. Diabetes.
POSTOPERATIVE DIAGNOSIS(ES): The same
PROCEDURE PERFORMED:
1. Right wrist irrigation and debridement with excisional debridement past the level of the fascia.
2. Extensive debridement of extensor tenosynovium as well as the joint capsule.
3. Decompression of capitate.
ANESTHESIA: General.
ANTIBIOTICS: Ancef after cultures were obtained.
PREP: CholraPrep.
TOTAL TOURNIQUET TIME: 49 minutes.
INDICATION FOR PROCEDURE: Patient is a 51-year-old male who arrived at my office yesterday due to chronic wrist pain of three months duration. He has seen multiple providers for it and has been prescribed steroids. He went to an outside hospital on February 11 where an aspirate was obtained. There were no crystals in aspirate. Cultures did grow Serratia marcescens. However, he only received one dose of IV antibiotics with continued pain. He had an MRI showing destructive changes seen throughout his carpal bones as well as extensive inflammation. He had elevated inflammatory markers. I admitted him that night with intention on performing incision and drainage the following morning due to the chronicity of his condition. He did understand that there was already destructive changes throughout his carpal bones and that the goal of surgery was to eradicate the infection, but he would likely need further procedures down the future secondary to the destruction of his wrist joint. Risks and benefits of the procedure including but not limited to infection, bleeding, injury to adjacent nerves, vessels, tendons, continued pain and weakness, need for further procedures, inability to eradicate infection was discussed. He understood the risks and benefits of the procedure and elected to proceed.
DESCRIPTION OF PROCEDURE: Patient was placed supine on the operating room table and all bony prominences were well-padded. He was prepped and draped in normal sterile fashion. Surgical time-out was performed with two patient identifiers confirming correct laterality and procedure to be performed. The limb was elevated. Tourniquet was inflated. A longitudinal incision was made over the dorsum of the wrist joint. Crossing veins were cauterized. The extensor retinaculum was opened up for the distal two-thirds. Extensive hemorrhagic synovium over the extensor tendons was identified and sharply debrided. The wrist joint itself was very boggy and inflamed. A fresh blade was used to incise to the wrist joint. There was some purulent material expressed from this. Multiple cultures were obtained of the synovium of the extensor tendons, the joint capsule itself as well as culture swabs of the wrist joint itself. Fluoroscopy was used to confirm level of the capitate and a 2 millimeter drill was used to drill on the dorsal aspect to decompress that area as there were cystic changes and fluid seen within the MRI. 6 liters of gravity irrigation was performed throughout the wrist joint, as well as extensor synovium. A deep drain was placed into the joint capsule itself and it was sutured to the skin. The extensor retinaculum was closed with 4-0 PDS. The skin was closed with nylon suture. Xeroform, 4 X 4, cast padding as well as an Ace was placed as a dressing. He was placed into a neutral splint.
I was attending of record and all counts were correct.
POSTOPERATIVE PLAN: Infectious disease will be consulted for assistance with antibiotic management.
Any and all help is appreciated.