Operative Note |
PROCEDURE: Right shoulder decompression. |
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SUMMARY: The patient was brought
to the operating room and placed supine on the operating table. He was given a general anesthetic and a gram of Ancef IV. He was then placed in the beachchair position and the right shoulder and arm were prepped and draped in the usual manner. A
6 sonometer incision was made over the right shoulder superiorly and anteriorly, centered over the acromioclavicular joint with the
distal end of the incision lateral to the coracoid. Incision was made with the knife and medial and lateral flaps were created. The periosteum over the distal clavicle was incised and distal sonometer of the clavicle was osteotomized and removed. The deltoid
was reflected off the anterior 3 mm of the acromion and removed, and the inferior acromioplasty was performed with the saw. Os acromiale was present, which is a congenital nonunion or failure to fuse of the acromion. There was a large fragment, so
the base acromion was not removed. The rotator cuff was noted to be intact, so after drill holes were placed in the acromion,
the deltoid was sutured back to the acromion in a horizontal pants-over-vest manner. Over the clavicular defect, the anterior
deltoid was repaired to the posterior deltoid to cover the clavicular defect. The subcutaneous was closed with interrupted 0
Vicryl and the skin was closed with 3-0 nylon staples. The deltoid was repaired back to the acromion in a standard manner with
2-0 Ethibond. The incision was covered with Xeroform, 4X4s and tape. A right shoulder immobilizer was applied. Blood
loss was less than 100 mL.
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