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Phalanx Enchondroma Excision And Bone Grafting Sample Report


PREOPERATIVE DIAGNOSIS:  Left long finger enchondroma.

POSTOPERATIVE DIAGNOSIS:  Left long finger enchondroma.

1.  Excision of left long finger proximal phalanx enchondroma.
2.  Bone grafting to left long finger proximal phalanx with distal radius autograft.

SURGEON:  John Doe, MD 


DESCRIPTION OF OPERATION:  The patient was brought to the operating room and positioned supine on the operating table. A time-out was taken to confirm and review the patient's identity, procedure, laterality and surgical plan, reviewed and confirmed. Then, 1 g of IV cefazolin was administered and general anesthesia was induced. A left arm tourniquet was placed and the left upper extremity was then prepped and draped in the standard sterile surgical fashion. The planned curvilinear incision was marked out about the dorsum of the long finger, centered about the proximal phalanx. A secondary longitudinal incision was then marked out, near Lister tubercle. After exsanguination, an additional incision was made. This was carefully carried down through the subcutaneous tissue, preserving all dorsal veins where possible. The sagittal band was then identified and split longitudinally with a small cuff for repair. The periosteum was then incised longitudinally and subperiosteal elevation revealed the area of the mass in the proximal phalanx. A 0.045 inch K-wire was used as a drill and outlined the periphery of the mass. This was removed and immediately apparent was a mucinous and partially calcified mass consistent with an enchondroma. This was then meticulously removed using curettes under loupe magnification and sent off as specimen. A 4 mm bur was then used to bur the cavity, and after irrigation, there only appeared to be healthy bleeding bone remaining. All specimens were also removed from the trapdoor cortical fragment. Attention was then turned towards the distal radius. A longitudinal incision was made and carefully carried down to the level of Lister tubercle. This was then subperiosteally exposed. An osteotome was then used to remove Lister tubercle and angled curettes were then used to harvest the necessary bone graft to fill the defect distally. Separate instruments were used, and after a satisfactory amount of bone graft had been harvested, this was passed into the cavitary defect. The wrist incision was then infiltrated with 0.5% Marcaine with epinephrine and skin incision reapproximated using interrupted 4-0 Monocryl suture. The trapdoor dorsal cortical piece was then replaced after satisfactory tapping of the bone graft. Portable fluoroscopy was used to confirm satisfactory filling of the defect, and after confirming hemostasis, the periosteum was repaired over the defect using interrupted 4-0 Monocryl suture. A single figure-of-eight 4-0 Monocryl suture was then used to repair the sagittal band followed by a running 4-0 nylon stitch for the skin. The hand was then washed and dried and additional 0.5% Marcaine with epinephrine was injected in the skin about the incisions. Adaptic, bacitracin and dry sterile dressing was placed followed by a well-padded dorsal protective splint in the same position. The tourniquet was let down with immediate reperfusion to the entire hand. Estimated blood loss was minimal. Sponge, needle and instrument count was correct x2. The patient will be seen back in 2 weeks for suture removal and serial x-rays.