Orthopaedics

Excision of Osteomyelitis Right Third Proximal Phalanx

PRE- AND POSTOPERATIVE DIAGNOSIS:  Hanson’s Disease and osteomyelitis of right third finger stump.

OPERATION PROCEDURE PERFORMED:  Excision of osteomyelitis right third proximal phalanx and revision amputation at MPJ level. 

SURGEON:  S, MD.

ANESTHETIC:  IV sedation with metacarpal block 10 cc 1 percent Xylocaine and 0.25 percent Marcaine plain. 

COMPLICATIONS:  None.

TOURNIQUET TIME:  30 minutes.

INDICATIONS:  This is a gentleman who has Hanson’s disease and osteomyelitis of the remnant of his right third finger.  This is about the proximal 1/3 of his proximal phalanx, and there is a draining open area there, which has been controlled, except for the local process, with oral antibiotics.  The patient understands the risks, benefits and alternatives of this procedure, the procedure itself, and wishes to proceed with excision of the remnant of the proximal phalanx.  He understands the problems of recurrent infection, anesthetic problems, and the possibility of wound healing issues.

FINDINGS:  This was osteomyelitis of the remnant of the proximal phalanx.  It came out beautifully.  Closed nicely.

DESCRIPTION OF PROCEDURE:  After receiving IV sedation and the metacarpal block of 1 percent Xylocaine and 0.25 percent Marcaine, I made a dorsal incision over the remnant of the proximal phalanx and then converted this to a circular incision around the heavily calloused and infected skin at the very tip of the stump.  This heavily calloused skin was excised.  I then excised the extensor tendon back to the MPJ level.  I opened the capsule and subperiosteally dissected the remnant of the proximal phalanx out and removed it.  I used the rongeur to remove the articular cartilage off of the end of the metacarpal and then I used a rasp to smooth this out, and then dissected and pulled out the flexor tendon and cut it short.  I then applied both neurovascular bundles, dissected these, and pulled these distally, and then cut them short so that they would not be in the wound, cauterizing the vessels.  I then irrigated the wound copiously with antibiotic saline solution and closed it over a ¼ inch Penrose drain with 4-0 nylon sutures. It closed beautifully.  I then dressed the wound with a sterile bulky dressing and then released the tourniquet, which was placed on the forearm.  It was up for about 30 minutes.  There was good revascularization of the remnant of the hand.  The patient was then taken to the Recovery Room in good condition.  Tolerated the procedure well.  The sponge, needle count, and instrument count are correct.

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