DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Left carpal tunnel syndrome.
2. Left wrist dorsal ganglion.
3. Recurrent mild right carpal tunnel syndrome.
POSTOPERATIVE DIAGNOSES:
1. Left carpal tunnel syndrome.
2. Left wrist dorsal ganglion.
3. Recurrent mild right carpal tunnel syndrome.
OPERATION PERFORMED:
1. Left wrist dorsal ganglion excision.
2. Left carpal tunnel release.
3. Corticosteroid injection, right carpal tunnel.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: General.
TOURNIQUET TIME: 45 minutes on the left forearm.
FLUIDS GIVEN: Lactated Ringer’s.
SPECIMENS: Dorsal wrist mass, left, sent to pathology.
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old with a history of bilateral carpal tunnel syndrome. The patient had a recurrence on the right and underwent a revision carpal tunnel release with improvement. He now developed mild symptoms and also has been complaining of increasing left carpal tunnel symptoms and has also developed the dorsal ganglion on the left wrist as well. Despite nonoperative treatment including splinting, anti-inflammatory medicines, previous corticosteroid injections, the patient still has persistent symptomatology. The patient now presents for operative treatment. The risks and benefits of the surgery including infection, bleeding, recurrence, possible incomplete relief of symptoms and possible need for repeat surgery were explained to the patient. The patient understood the risks and benefits and wished to proceed.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed on the operating table in the supine position. General anesthesia was induced. A total of 1 mL of Depo-Medrol and 3 mL of Marcaine was injected into the right carpal tunnel under sterile conditions. Attention was then turned to the left upper extremity. This was prepped and draped in the usual sterile fashion. The limb was exsanguinated and the tourniquet was inflated to 250 mmHg.
At this point, a longitudinal incision was made in the base of the palm in line with the fourth ray. This incision was carried through skin and subcutaneous tissue. The superficial fascia was divided. Transverse carpal ligament was identified and divided. At this point, a KMI SafeGuard carpal tunnel guide was placed deep to the transverse carpal ligament and the remaining proximal portion of the ligament was divided with the KMI SafeGuard carpal tunnel knife. At this point, the entire ligament was completely divided and the median nerve was found to be completely free without injury. At this point, the wound was copiously irrigated with normal saline. The skin was closed with 4-0 nylon vertical mattress sutures. Attention was then turned to the dorsum of the left wrist. A transverse incision was then made over the area of the dorsal ganglion. This incision was carried through skin and subcutaneous tissue. Blunt and sharp dissection was performed. The mass was identified and found to be adherent to the underlying extensor tendon sheath. The extensor tendon sheath bent over the EPL and ECRL and ECRB was then incised along with the mass. The mass was then traced back to the area of the scapholunate interval and the entire mass along with the stalk was excised along with a piece of the dorsal capsule.
Once this was done, the wound was copiously irrigated with normal saline. The base of the capsule was cauterized with Bovie electrocautery and the skin was closed with 4-0 Vicryl single interrupted sutures and 4-0 nylon running subcuticular suture. This was done after the wound was copiously irrigated with normal saline. Bulky sterile dressing and a volar splint was applied. The patient tolerated the procedure well and was taken to the recovery room in stable condition.
