Preoperative
Diagnosis: Dupuytren’s contracture
Postoperative
Diagnosis: Same
Procedure Performed:
Biopsy of mass, volar aspect right hand
Anesthesia:
Medial and ulnar nerve block
Findings:
This 48-year-old white female has been struggling
with a lump over the volar aspect of her right hand
for several months. The mass is firm, fixed, and appears
to be getting larger. The patient notes discomfort
in this region when she grasps objects such as a broom
handle. Differential diagnosis includes early Dupuytren’s
contracture vs. epidermoid inclusion cyst. Excision
was recommended and the patient presents for same
at this time. She is aware of the risks and benefits
of the procedure and wishes to proceed.
Description
of Procedure: After adequate anesthesia was
achieved the right upper extremity was prepped and
draped in the standard sterile orthopedic fashion.
A modified Brunner incision was made over the fifth
ray and dissection carried down through subcutaneous
tissue. The neurovascular bundles of the fourth and
fifth rays were identified and protected. The mass
was isolated and noted to extend off the pretendinous
fascia in a palmar direction. The pretendinous fascia
was excised over the fifth ray for a distance of approximately
3 cm. The mass was mobilized off the subcutaneous
tissue with a #69 Beaver blade. The remaining skin
over this area was noted to be thin. Pretendinous
fascia over the fourth ray was also partially excised
as the mass was noted to be adhesed at this site as
well. Flexor tendons were intact. Further exploration
of the wound revealed no evidence of significant involvement
of the pretendinous fascia up into the MCP area distally
of either the fourth or fifth ray.
Once all dissection
was completed the wound was copiously irrigated with
Kefzol solution. A 4-0 PDS suture was used to close
the deep tissues and the skin was closed with 4-0
nylon. The tourniquet was released and the operative
site was noted to turn appropriately pink with blood
return. A sterile op site dressing was applied and
the patient was returned to the recovery area in stable
condition.
Pathology report returned
with features consistent with Dupuytren’s contracture.
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