gistfile1.txt

The patient was identified in the preoperative holding area.  The left  thumb was marked as the correct surgical site with the patient's agreement.  A regional block was placed by the Anesthesia Service. She was taken back to the operating room and moved onto the OR table with all bony prominences well padded. A tourniquet was applied to the left  arm. Pre-operative antibiotics were given. Sedation was induced. The left  arm was then prepped and draped in usual sterile fashion.  A time-out was performed confirming correct patient, surgical site, and procedure.  An Esmarch was applied and the tourniquet was inflated to 250 mmHg.  A longitudinal incision was made from the base of the first metacarpal to the radial styloid.  Sharp dissection was carried down through skin only.  Tenotomy dissection was then used to dissect down to the level of the first dorsal compartment. The dorsal radial sensory nerve branch was identified and was mobilized and protected in the skin flaps. The first dorsal compartment was incised dorsally under direct visualization. This was completely released, and there was not a separate subsheath for the EPB.  The EPB and APL tendons were released distally and a self retainer was placed between the 2 tendons. Tenotomy dissection was then used to identify the radial artery. The branches heading distally were cauterized.  Dissection was carried down through the capsule using a needle tip Bovie from the base of the first metacarpal to the trapezium scaphoid joint. The capsule was carefully elevated off the base of 1st metacarpal and trapezium. Small loose bodies were identified and removed. After the trapezium was adequately exposed, an osteotome was used to bisect the trapezoid which was then removed piecemeal with a rongeur. There was not significant arthritis between the scaphoid and the trapezoid.  There were no bony fragments left in the arthroplasty site. The FCR tendon was identified and was intact. At this point, two passes with a 2-0 FiberWire suture were made from the APL to the distal aspect of the FCR tendon. Gentle longitudinal traction was applied to the thumb and downward pressure was placed on the base of the first metacarpal and the suture was tied creating a suspensionplasty between the APL and the FCR.The thumb was stable to axial load and was nicely abducted. The wound was then copiously irrigated. The capsule was then closed in a pursestring fashion using a 2-0 PDS suture. The wound was again irrigated and the tourniquet was let down. Hemostasis was achieved and there was no bleeding from the radial artery.  The skin was then closed with 4-0 nylon horizontal mattress sutures.  The incision was dressed with bacitracin ointment, Adaptic, 4x4s, sterile Webril, and a thumb spica splint.  The patient was then awoken from sedation and taken to recovery room in stable condition.