Documenting a plastic surgery list
Operation notes dictated between cases, hand therapy referrals, work certificates and letters to the GP.
A zone 2 flexor tendon repair
Left ring finger, zone 2 flexor injury from glass last night. Carpenter, right-handed.
Wide awake, lignocaine 1% with adrenaline, no tourniquet.
FDP completely divided. FDS ulnar slip divided, radial slip intact. Ulnar digital nerve divided, radial nerve and both arteries intact.
FDP repaired with a four-strand core suture, 3-0, and a 6-0 epitendinous. FDS ulnar slip repaired. Ulnar digital nerve 9-0 nylon under loupes.
Active flexion checked on the table, no gapping, no triggering.
Dorsal blocking splint. Hand therapy day three, early active motion. Off work twelve weeks. Rooms at two weeks.
Indication
L ring finger zone 2 flexor tendon laceration (glass). Right-hand dominant carpenter.
Anaesthesia
WALANT: lidocaine 1% with adrenaline. No tourniquet.
Findings
FDP complete division. FDS ulnar slip divided, radial slip intact. Ulnar digital nerve divided. Radial digital nerve and both digital arteries intact.
Repair
FDP: 4-strand core suture (3-0), 6-0 epitendinous. FDS ulnar slip repaired. Ulnar digital nerve: 9-0 nylon epineurial repair under loupes. Active flexion tested intraoperatively: no gapping or triggering.
Plan
- Dorsal blocking splint
- Hand therapy day 3, early active motion protocol
- Off work 12 weeks
- Review in rooms at 2 weeks
After the case
- Hand therapy referral
- The structures repaired, the repair strength, the splint position and the protocol to start.
- Work certificate
- Unfit for his usual duties as a carpenter, with the review dates.
- Letter to the GP
- The injury, the repair and why the hand therapy appointments matter.
