Operative Note

PROCEDURE:   Small finger ray resection.

SUMMARY:  The patient was brought to the operating room and placed supine on the operating table and given a general anesthetic.  A tourniquet was placed about the arm, and the extremity was prepped and draped in the usual manner.  The limb was elevated and exsanguinated with an Ace wrap, and the tourniquet was inflated to 250 mm/Hg for 45 minutes.  A ratchet incision was made about the base of the proximal phalanx, and incision dorsally made over the course of the fifth metacarpal.  The incision was initially made on the ulnar aspect of an ulcer, which was eventually cut out.  The dissection was carried down to the metacarpal and then out the ratchet incision as stated for the proximal phalanx. The finger was disarticulated at the metacarpophalangeal joint prior to removing the fifth metacarpal from its bed.  The neurovascular bundles were seen and protected, especially to the ring finger.  The entire small finger metacarpal was removed.  A culture of the base was obtained and submitted to microbiology as stated above.  The ulcer on the residual dorsum of the right hand was excised and the volar flap brought dorsally for closure with 4-0 nylon.  Once closed, the incision was covered with Xeroform, Kerlix, and a volar wrist splint with the wrist in mild dorsiflexion.  The splint was held on with Ace wrap. 

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