PREOPERATIVE DIAGNOSES: (1) Massive tear of the right rotator cuff. (2) Acromioclavicular arthritis. (3) Severe impingement syndrome of the right shoulder.
POSTOPERATIVE DIAGNOSES: (1) Massive tear of the right rotator cuff. (2) Acromioclavicular arthritis. (3) Severe impingement syndrome of the right shoulder.
OPERATION PERFORMED: (1) Manipulation under anesthesia. (2) Anterior and inferior acromioplasty. (3) Mumford procedure. (4) Repair of the right rotator cuff.
SURGEON: A. Lincoln, M.D.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 20 cc.
POSTOPERATIVE IMMOBILIZATION: Sling.
DESCRIPTION OF OPERATIVE PROCEDURE: Under satisfactory anesthesia, the patient was put in a semi-sitting position on the table and the right shoulder was prepped and draped in the usual sterile manner.
An anterior incision was made from the acromioclavicular joint distally and it was carried down through the subcutaneous fascia. The deltoid muscle and fascia were exposed. The portion between the anterior and lateral segment of the muscle was opened bluntly and anterior capsule of the joint was exposed. The incision was then extended proximally in a T-shape and the horizontal portion was on the acromion. This gave an access to the acromion laterally and also to the acromioclavicular joint medially. The joint was then cleaned, and protecting the soft tissue, 1-cm of the clavicle was excised. A significant impingement was encountered due to an overhanging anterior acromion. Acromioplasty was done using the oscillating saw and the anterior acromion was excised and this was followed by removal of the inferior acromion, creating a significant amount of room for the subacromial contents. After this was accomplished, the bursa was opened and a very large tear of the right supraspinatus was noted. The edge of the tendon was freshened with a fresh knife and approximately 1-mm of that edge was removed in order to gain fresh tissue. The greater tuberosity was then trimmed and a raw bone was produced by the oscillating saw. Two drill holes were introduced into the greater tuberosity from distal to proximal part, with the hole exiting just next to the ruptured portion of the cuff. Two #5 Ethibond were then passed through those holes and through the ruptured portion of the cuff and was tightly sutured. This completely closed the gap which he had due to the rupture. Several small 0-Ethibond sutures were used to reinforce the cuff on the lateral and medial side. The arm was put on internal rotation and no major tear was encountered in the infraspinatus and the teres minor.
Next, was repair of the deltoid back to the acromion two drill holes. A corner suture was applied on the acromion accommodating the two portions of the deltoid, medially and laterally. This was followed by closing the acromioclavicular joint and the rest of the tissue of the incision laterally, using 0-Ethibond suture. The rest of the deltoid fascia was closed using 2-0 Vicryl. The subcutaneous tissue was then closed using 2-0 Vicryl. The skin was closed using 4-0 Monocryl in a subcuticular fashion. Then a sterile dressing and a sling were applied. The patient returned to the postanesthesia care unit in satisfactory condition.
No comments:
Post a Comment