This is the report they left about how the surgery went.
General
Operative Technique: Patient was seen in the preoperative holding suite informed consent reviewed. Patient was then taken from the preoperative holding area to the operative suite and transferred from the gurney to the table. All bony prominences were padded. General anesthesia was administered. Patient was then transferred from supine the lateral position with the affected upper extremity draped over an arm holder. Preoperative antibiotics were administered. Sterile standard prep and drape were then performed. Operative time-out was performed identifying patient and correct left upper extremity. Esmarch used to exsanguinate the arm and the Tourniquet inflated 250 mm Hg. An 8 cm curvilinear incision coursing lateral to the tip of the olecranon was performed with a 10 blade. Retractors were placed. Triceps tendon was completely avulsed, all 3 heads, from the olecranon process with retraction. We utilized a Cobb elevator to develop planes both superficial and deep to all 3 heads and allow for better excursion of the tendon. The tendon ends were freshened with a 15 blade as well as rongeur. Allis clamp was placed on the tendon heads and adequate excursion confirmed. We then began preparation for a triceps repair. We used a rongeur to debride the stump and freshen the bone for adequate healing surface on the olecranon process. Following this, we then placed 2 475 double loaded SwiveLock Arthrex anchors with preloaded tape as well with excellent purchase in the olecranon process and no penetration of the intra-articular area. These FiberWire sutures were then passed sequentially in a horizontal mattress fashion in both the medial head as well as the long and lateral heads of the tendon. The fiber tapes were also passed in horizontal mattress fashion just proximal to previous past fiber wires. The arm was brought into near full extension for repair. We then sequentially tied all 4 knots for the horizontal mattress repair with the FiberWire sutures noting excellent compression at the anatomic insertion site of the triceps on the olecranon process. We cut 2 of these sets of sutures and left the other 2 for our speed bridge construct. We then drilled and tapped 2 more pilot holes for lateral row of our speed bridge construct. We then incorporated our FiberTape as well as the remaining 4 strands of suture in a speed bridge construct, noting excellent tension and compression of the repair at its anatomic insertion site and dunked these into 2 475 swivel lock anchors and our lateral row along the ulnar shaft, approximately 3 to 4 cm distal to the initial set of anchors placed. Our construct was then complete. We had excellent restoration of the triceps insertion site and excellent compression with our speed bridge construct. Flexed and extended the elbow from 0-100 with no undue tension and no undue stress on the repair. Content with our construct, we then turned our attention to closure. Copious irrigation was then carried out. Deep fascia was closed with 2 O Vicryl as well as deep dermal layer closed with 2 O Vicryl. This was followed by Monocryl for 0 subcuticular layer runner. Dermabond and Steri-Strips were then placed. Soft dressing and Ace bandage were then placed as well. Patient is then placed in a sling. All sponge and needle counts were correct at the end the procedure. Patient 1 or go passive range of motion from 0-110 as tolerated. We will begin physical therapy after his 1st postoperative visit.
The physician's assistant was 1st assistant during this case, was present for the entirety of the case and assisted with all critical portions of the case. Prior to the procedure he was involved with room setup, patient positioning, prepping and draping. Intraoperatively he assisted with retraction and manipulation of the extremity, tendon reduction, reaming, anchor placement. Post-procedure he assisted with subcutaneous wound closure. He directly performed skin closure and dressing application. He also was involved with transferring the patient from the OR bed to the hospital bed.
Complications: None
Additions (Drains, Specimens, Implants):
Implants:
Implant Name
Type
Inv. Item
Serial No.
Manufacturer
Lot No.
LRB
No. Used
Action
ANCHOR SUT 4.75MM 2 SWIVELOCK TIGERWIRE ARTHX 2 LD 2 TIP EA=BILL-ONLY - LOG4823077
Anchor
ANCHOR SUT 4.75MM 2 SWIVELOCK TIGERWIRE ARTHX 2 LD 2 TIP EA=BILL-ONLY
Arthrex
14921228
Left
1
Implanted
ANCHOR SUT 4.75MM 2 SWIVELOCK TIGERWIRE ARTHX 2 LD 2 TIP EA=BILL-ONLY - LOG4823077
Anchor
ANCHOR SUT 4.75MM 2 SWIVELOCK TIGERWIRE ARTHX 2 LD 2 TIP EA=BILL-ONLY
Arthrex
14962105
Left
3
Implanted
Estimated Blood Loss: * No values recorded between 5/6/2024 12:03 PM and 5/6/2024 1:03 PM *
Total IV Fluids:
Intravenous fluids were administered See Anesthesia Record
Tourniquet Time: See OR Record
Condition: good
Findings: As dictated
