Medical Transcription
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS
Left carpal tunnel syndrome.
POSTOPERATIVE DIAGNOSIS
Left carpal tunnel syndrome.
OPERATION
Left carpal tunnel decompression.
ANESTHESIA
IV regional.
PROCEDURE FINDINGS
The left transverse carpal ligament was moderately thickened, and it was causing moderate compression of the left median nerve in the carpal tunnel.
DETAILS OF PROCEDURE
The patient was brought conscious to the operating room and placed on the operating table in the supine position with the left arm abducted out on an arm board. After the anesthesiologist secured an IV regional anesthetic and left the tourniquet inflated, the left hand, wrist, and forearm were prepped with Techni-Care and draped using sterile towels in the usual fashion. Marcaine 0.5% plain was infiltrated into the skin and subcutaneous tissue, and then an incision was made at the base of the left palm and on the volar aspect of the left wrist. The incision was carried into the subcutaneous tissue. In the proximal portion of the wound, the investing fascia was identified and longitudinally incised. With care to stay on the ulnar side of the nerve, the palmar fascia then transverse carpal ligament were incised all the way to the end of the carpal tunnel. Again with care to stay on the ulnar side of the nerve, the investing fascia was incised well into the forearm. Some filmy adhesions of the transverse carpal ligament to the median nerve were sharply incised. At this time I was convinced I had released all compression off of the nerve. The skin edges were then reapproximated with interrupted vertical mattress 4-0 nylon suture with care to reapproximate skin crease lines. The tourniquet was deflated after 19 minutes total time. The wound was hemostatic. Dressing of Xeroform followed by dry gauze with gauze between the fingers, then Webril, then volar plaster splint strips, then Kling wrap and Ace wrap was applied with the wrist in a neutral position. The
PREOPERATIVE DIAGNOSIS
Left carpal tunnel syndrome.
POSTOPERATIVE DIAGNOSIS
Left carpal tunnel syndrome.
OPERATION
Left carpal tunnel decompression.
ANESTHESIA
IV regional.
PROCEDURE FINDINGS
The left transverse carpal ligament was moderately thickened, and it was causing moderate compression of the left median nerve in the carpal tunnel.
DETAILS OF PROCEDURE
The patient was brought conscious to the operating room and placed on the operating table in the supine position with the left arm abducted out on an arm board. After the anesthesiologist secured an IV regional anesthetic and left the tourniquet inflated, the left hand, wrist, and forearm were prepped with Techni-Care and draped using sterile towels in the usual fashion. Marcaine 0.5% plain was infiltrated into the skin and subcutaneous tissue, and then an incision was made at the base of the left palm and on the volar aspect of the left wrist. The incision was carried into the subcutaneous tissue. In the proximal portion of the wound, the investing fascia was identified and longitudinally incised. With care to stay on the ulnar side of the nerve, the palmar fascia then transverse carpal ligament were incised all the way to the end of the carpal tunnel. Again with care to stay on the ulnar side of the nerve, the investing fascia was incised well into the forearm. Some filmy adhesions of the transverse carpal ligament to the median nerve were sharply incised. At this time I was convinced I had released all compression off of the nerve. The skin edges were then reapproximated with interrupted vertical mattress 4-0 nylon suture with care to reapproximate skin crease lines. The tourniquet was deflated after 19 minutes total time. The wound was hemostatic. Dressing of Xeroform followed by dry gauze with gauze between the fingers, then Webril, then volar plaster splint strips, then Kling wrap and Ace wrap was applied with the wrist in a neutral position. The