Quiz Q2

Physician Portal

SIGNED Report Name Dictatina Phvsician Medical Record Number Account Number Date Of Birth

Operative Note EMR No Cosion

Dictation Date/Time Transcriotion Date/Time Document ID Admit Date Discharae Date

Operative Report

Date/Time N ote Created:

Procedure(s) Performed: Primary flexor tendon repair for complete transection to the left flexor digitorum profundus tendon to the ring finger (Zone II) Primary flexor tendon repair for complete transection to the left flexor digitorum profundus tendon to the small finger (Zone II) Primary flexor tendon repair for complete transection to the left flexor digitorum superficialis tendon radial slip to the ring finger (Zone II) Primary flexor tendon repair for complete transection to the left flexor digitorum superficialis tendon ulnar slip to the ring finger (Zone II)

Primary Surgeon(s):

Assisted By:

Anesthesiologist/CRNA:

Anesthesia Type: General

Preoperative Antibiotic: Ancef_

Tourniquet time 120 minutes https://physicianportal.etenet.com/PhysicianPortal/Default.aspx

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Physician Portal

Pre-Operative Diagnosis: Traumatic laceration of left ring and small finger_

Post-Operative Diagnosis: Traumatic laceration of ring and small finger_

Indications for Procedure: Patient is a 24-year-old male who sustained a self-inflicted wound to the left ring and small finger with sharp blade.

Patient reveal evidence of flexor

tendon injury on exam. Patient was neurovascularly intact. The risks, benefits, expectations, and alternatives of flexor tendon repair were discussed with the patient including bleeding, infection, nerve injury, tendon injury and need for multiple surgeries to correct the injury. The patient read and signed the consent form and verbalized full understanding. The patient was identified and timeout confirmed the correct site for the procedure. The patient was positioned appropriately. Surgical site preparation was performed with Betadine and draped in standard sterile fashion.

Description of Procedure(s): Attention was directed to performance of Primary flexor tendon repair for complete transection to the left flexor digitorum profundus tendon to the ring finger (Zone !!)Primary flexor tendon repair for complete transection to the left flexor digitorum profundus tendon to the small finger (Zone !!)Primary flexor tendon repair for complete transection to the left flexor digitorum superficialis tendon radial slip to the ring finger (Zone !!)Primary flexor tendon repair for complete transection to the left flexor digitorum superficialis tendon ulnar slip to the ring finger (Zone II).

Attention was directed to the left flexor digitorum profundus tendon to the ring finger (Zone II). The extremity was then exsanguinated with the use of an Esmarch bandage and the tourniquet was inflated.

The tourniquet was inflated to a pressure of 200 mmHg. Tendon exposure was achieved through the existing traumatic laceration. The tendon was identified and dissected free of surrounding structures to achieve mobility. Care was paid to avoidance of injury to adjacent structures, https://physicianportal.etenet.com/PhysicianPortal/Default.aspx

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Physician Portal including nerves and blood vessels in proximity to the tendon. Exposure was achieved through a palmar Bruner-style incision over the injury site. The tendon was mobilized with great care paid to avoidance of injury to the adjacent neurovascular structures or other tendons.

Tendon mobilization was then performed. The tendon ends were mobilized with careful dissection and brought into apposition for end-to-end repair.

Fixation was accomplished as follows. A Modified Kessler suture technique was used for tendon approximation.

Core sutures of 4-0 Ethibond were placed for tendon approximation. A total of 4 core sutures were used. Epitendinous sutures of 5-0 Nylon were then placed.

Hemostasis was achieved with biterminal bipolar electrocoagulation. Wound closure was then accomplished as follows. The epidermis was closed with 4-0 Nylon in interrupted fashion. The wound was copiously irrigated after repair with sterile saline solution and any particulate debris removed. The tourniquet was released and a compressive bandage was applied. Hand perfusion was excellent.

The operative site was immobilized with a dorsal wrist splint.

Attention was directed to the left flexor digitorum profundus tendon to the small finger (Zone II). The extremity was then exsanguinated with the use of an Esmarch bandage and the tourniquet was inflated.

The tourniquet was inflated to a pressure of 200 mmHg. Total tourniquet time was 120 min.

Tendon exposure was achieved through the existing traumatic laceration. The tendon was identified and dissected free of surrounding structures to achieve mobility. Care was paid to avoidance of injury to adjacent structures, including nerves and blood vessels in proximity to the tendon. Exposure was achieved through a palmar Bruner-style incision over the injury site. The tendon was mobilized with great care paid to avoidance of injury to the adjacent neurovascular structures or other tendons.

Tendon mobilization was then performed. The tendon ends were mobilized with careful dissection and brought into apposition for end-to-end repair.

Fixation was accomplished as follows. A Modified Kessler suture technique was used for tendon approximation. https://physicianportal.etenet.com/PhysicianPortal/Default.aspx

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Physician Portal Core sutures of 4-0 Ethibond were placed for tendon approximation. A total of 2 core sutures were used. Hemostasis was achieved with biterminal bipolar electrocoagulation. Wound closure was then accomplished as follows. The epidermis was closed with 4-0 Nylon in interrupted fashion. The wound was copiously irrigated after repair with sterile saline solution and any particulate debris removed. The tourniquet was released and a compressive bandage was applied. Hand perfusion was excellent.

The operative site was immobilized with a dorsal wrist splint.

Attention was directed to the left flexor digitorum superficialis tendon radial slip to the ring finger (Zone II).

The tourniquet was inflated to a pressure of 200 mmHg. Tendon exposure was achieved through the existing traumatic laceration. The tendon was identified and dissected free of surrounding structures to achieve mobility. Care was paid to avoidance of injury to adjacent structures, including nerves and blood vessels in proximity to the tendon. Exposure was achieved through a palmar Bruner-style incision over the injury site. The tendon was mobilized with great care paid to avoidance of injury to the adjacent neurovascular structures or other tendons.

Tendon mobilization was then performed. The tendon ends were mobilized with careful dissection and brought into apposition for end-to-end repair.

Fixation was accomplished as follows. A 4-strand cruciate suture technique was used for tendon approximation.

Core sutures of 4-0 Ethibond were placed for tendon approximation. A total of 2 core sutures were used. Hemostasis was achieved with biterminal bipolar electrocoagulation. Wound closure was then accomplished as follows. The epidermis was closed with 4-0 Nylon in interrupted fashion.

The operative site was immobilized with a dorsal wrist splint.

Attention was directed to the left flexor digitorum superficialis tendon ulnar slip to the ring finger (Zone II).

The tourniquet was inflated to a pressure of 200 mmHg. Tendon exposure was achieved through the existing traumatic laceration. The tendon was identified and dissected free of surrounding structures to achieve mobility. Care was paid to avoidance of injury to adjacent structures, https://physicianportal.etenet.com/PhysicianPortal/Default.aspx

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Physician Portal including nerves and blood vessels in proximity to the tendon. Exposure was achieved through a palmar Bruner-style incision over the injury site. The tendon was mobilized with great care paid to avoidance of injury to the adjacent neurovascular structures or other tendons.

Tendon mobilization was then performed. The tendon was mobilized to take tension off the laceration site and allow approximation of the lacerated segment.

Fixation was accomplished as follows. A 4-strand cruciate suture technique was used for tendon approximation.

Core sutures of 4-0 Ethibond were placed for tendon approximation. A total of 2 core sutures were used.

The A2 pulley system was reconstructed on both the ring and small finger hemostasis was achieved with biterminal bipolar electrocoagulation. Wound closure was then accomplished as follows. The epidermis was closed with 4-0 Nylon in interrupted fashion.

The operative site was immobilized with a dorsal wrist splint.

Finding(s): Complete transection of FDP , FDS of the ring and small finger

Complications: None_

Specimens Removed: None_

Implants/Explants: None_

Estimated Blood Loss: 10 cc_

Patient Condition: Stable_

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Physician Portal Attention was directed to performance of Primary flexor tendon repair for complete transection to the left flexor digitorum superficialis tendon to the ring finger (Zone III).

The risks, benefits, expectations, and alternatives of flexor tendon repair were discussed with the patient including bleeding, infection, nerve injury, tendon injury and need for multiple surgeries to correct the injury. The patient read and signed the consent form and verbalized full understanding.

The patient was identified and timeout confirmed the correct site for the procedure. The patient was positioned appropriately. Surgical site preparation was performed with Chloraprep and draped in standard sterile fashion.

Attention was directed to the left flexor digitorum superficialis tendon to the ring finger (Zone III). The extremity was then exsanguinated with the use of an Esmarch bandage and the tourniquet was inflated.

The tourniquet was inflated to a pressure of 200 mmHg. Tendon exposure was achieved through the existing traumatic laceration. The tendon was identified and dissected free of surrounding structures to achieve mobility. Care was paid to avoidance of injury to adjacent structures, including nerves and blood vessels in proximity to the tendon. Exposure was achieved through a palmar Bruner-style incision over the injury site. The tendon was mobilized with great care paid to avoidance of injury to the adjacent neurovascular structures or other tendons.

Tendon mobilization was then performed. The tendon ends were mobilized with careful dissection and brought into apposition for end-to-end repair.

Fixation was accomplished as follows. A Modified Kessler suture technique was used for tendon approximation.

Core sutures of 4-0 Ethibond were placed for tendon approximation. A total of 4 core sutures were used. Epitendinous sutures of 5-0 Nylon were then placed.

Hemostasis was achieved with biterminal bipolar electrocoagulation. Wound closure was then accomplished as follows. The epidermis was closed with 4-0 Nylon in interrupted fashion. The wound was copiously irrigated after repair with sterile saline solution and any particulate debris removed. The tourniquet was released and a compressive bandage was applied. Hand perfusion was excellent.

The operative site was immobilized with a dorsal wrist splint. https://physicianportal.etenet.com/PhysicianPortal/Default.aspx

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Physician Portal Electronically Signed

End of Report

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SIGNED

End of Report'

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