DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Right third finger crush injury.
2. Right third finger nail bed injury.
POSTOPERATIVE DIAGNOSES:
1. Right third finger crush injury.
2. Right third finger nail bed injury.
PROCEDURE PERFORMED: Repair of right third finger nail bed.
SURGEON: John Doe, MD
ANESTHESIA: Digital block with IV sedation.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old right-hand dominant male who crushed his right third fingertip in a metal door. He sustained significant trauma to the fingertip. There was underlying injury clinically. The patient was brought to the operating room for exploration of the wound and repair as needed under anesthetic. The procedure, postoperative protocol and all the risks and benefits were explained to the patient. These include, but are not limited to, nail deformity, neurovascular damage, tendon damage, soft tissue loss and even loss of life or limb. The patient understood all of this and agreed to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and laid supine on the operating table. General anesthetic was administered under the direction of the anesthesiologist. The patient was positioned comfortably with all bony prominences well padded.
The right upper extremity was prepped with DuraPrep and then draped out in the usual sterile fashion. Approximately 4 mL of 0.25% plain Marcaine was injected at the base of the third finger to provide a digital block. The nail was removed and there was some avulsion to the soft tissue over the distal nail bed and fingertip. There was evidence of injury to the nail bed distally and 2 simple stitches of 4-0 chromic were placed to secure the soft tissue down to the distal nail bed. The eponychial fold was lifted and then the nail was fashioned and secured down with a 4-0 chromic stitch under the eponychial folds so as to protect the nail bed and allow for future growth.
The wound was then irrigated with antibiotic solution and antibiotic ointment was placed over it with Adaptic. A soft dressing of rolled-up 4 x 4 and then 2 inch gauze was placed around the finger and the hand. Hand and wrist splints were applied and secured with an Ace wrap to protect the limb until seen in the office. The patient tolerated the procedure well. He was awoken from anesthesia and brought to the recovery room in stable condition.
