DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left distal biceps tendon rupture.
POSTOPERATIVE DIAGNOSIS: Left distal biceps tendon rupture.
OPERATION PERFORMED: Repair of left distal biceps tendon.
SURGEON: John Doe, MD
ANESTHESIA: General with axillary block.
ESTIMATED BLOOD LOSS: Minimal.
TOURNIQUET TIME: 50 minutes at 250 mmHg.
INDICATIONS: The patient is a (XX)-year-old right hand-dominant male who felt a pop across his left elbow while lifting some type of object, apparently "heavy." An MRI confirmed distal biceps tendon rupture and he presents today for repair. The patient understands what the procedure entails, postoperative protocol and the risks and benefits, which include but are not limited to infection, wound dehiscence, tendon damage, neurovascular damage, re-rupture and even loss of life or limb. The patient understands all of these and agrees to proceed.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed supine on the operating table. An axillary block was administered. IV antibiotics were given preoperatively. The patient was positioned comfortably with all bony prominences well padded. General anesthetic was administered and the patient observed under the direction of the anesthesiologist.
The left upper extremity was prepped with DuraPrep and then draped out in the usual sterile fashion. A curvilinear incision was made transversely across the mid crease and extending distally along the radial aspect and slightly proximally along the ulnar aspect. The incision was carried down through the skin. Tenotomy scissors were used to divide the underlying subcutaneous tissue. Veins were retracted and small crossing veins cauterized. There was some residual hematoma. This was irrigated with antibiotic solution. The fascia was divided proximally and the distal biceps tendon identified. It was freed of its adhesions proximally and then brought out into the wound. The ends were freshened up sharply and any fibrous material debrided.
The dissection was then turned more distally. The tract of the distal biceps tendon of its normal attachment was followed down bluntly onto the proximal radius. The soft tissues were cleared and then retractors placed around the proximal radius. This allowed visualization of proximal radius with the forearm in supination. A periosteal elevator was used to clear off any soft tissues. The bone was roughened up with a bur. A DePuy Mitek Super QuickAnchor Plus was placed in the usual standard fashion. First, a hole was drilled to the appropriate depth and anchor placed in engaging the cortex. The sutures were brought out and then weaved into the distal end of the biceps tendon. The tendon was then placed down onto bone. The suture was tied down and then woven again, brought up another stitch into the tendon for additional fixation.
The wound was irrigated with antibiotic solution. The subcutaneous tissue was closed with inverted 2-0 Vicryl. Skin was closed with running 3-0 PDS. Steri-Strips were applied. A sterile compressive dressing was applied with Betadine-soaked Adaptic, 4 x 4's, Webril and then a splint was applied with the elbow at approximately 70 degrees of flexion and the forearm in supination. This was secured with an Ace wrap. The tourniquet was deflated after a total of 50 minutes. The patient tolerated the procedure well and was awakened from anesthesia and brought to the recovery room in stable condition.