Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Oak Park Surgery Center 860 Oak Park Blvd., Suite 102 Arroyo Grande, CA 94320 ♦ (805) 474-6383 OPERATIVE REPORT PATIENT NAME: MEDICAL RECORD NUMBER: DATE OF SURGERY: WILLIAMS, GAVIN 0018282 June 02, 2016 SURGEON: ASSISTANT: ANESTHESIOLOGIST: ANESTHESIA: ADAM D. ABROMS, M.D. NONE NOLAN HIGA, M.D. GENERAL PREOPERATIVE DIAGNOSES: 1. Congenital oculomotor palsy, Left Eye. 2. Extreme monocular exotropia, Left Eye. 3. Status post prior strabismus surgery, Left Eye. POSTOPERATIVE DIAGNOSES: 1. Congenital oculomotor palsy, Left Eye. 2. Extreme monocular exotropia, Left Eye. 3. Status post prior strabismus surgery, Left Eye. OPERATIVE PROCEDURES: 1. Hummelsheim transposition with Foster modification, Left Eye. 2. Strabismus surgery in setting of prior extraocular muscle surgery involving maximal resection and recession procedure of Left medial and Left lateral recti muscles, Left Eye. 3. Examination under general anesthesia, Left Eye, with forced duction testing. ESTIMATED BLOOD LOSS: 20 cc. COMPLICATIONS: None. PROCEDURE PERFORMED: The patient was brought to the operating suite where general anesthesia was induced. The patient was prepped and draped in the usual sterile manner for strabismus surgery. The lid speculum was placed in the left eye. An examination under general anesthesia was performed with loupe magnification and fiber optic illumination. Forced duction testing was then performed on the left eye and revealed that there was not significant restriction to adduction of the left eye. An inferonasal conjunctival fornix incision was created with scissors and carried through anterior Tenon’s fascia down to bare sclera. The left medial rectus was isolated on serial muscle hooks and cleaned of adjacent scar tissue involving the overlying conjunctiva and Tenon’s capsule and underlying sclera. The muscle was then released. Through the same inferonasal conjunctiva fornix incision, the left inferior rectus was then isolated with serial muscle hooks and cleaned of its anterior fascial attachments with sharp dissection. Page 1 of 2 Oak Park Surgery Center 860 Oak Park Blvd., Suite 102 Arroyo Grande, CA 94320 ♦ (805) 474-6383 OPERATIVE REPORT PATIENT NAME: MEDICAL RECORD NUMBER: DATE OF SURGERY: WILLIAMS, GAVIN 0018282 June 02, 2016 A 6-0 Vicryl double-armed S-29 suture was woven through the left inferior rectus with locking ties at either edge. The sutures were taped to the drape and the muscle was released. A second superonasal conjunctival fornix incision was then created on the left eye with scissors and carried through anterior Tenon’s fascia down to bare sclera. The left superior rectus was then isolated and sutured in a manner identical to that of the left inferior rectus. The left medial rectus was then again hooked through the inferonasal conjunctival incision. The left inferior rectus was then reattached with sclera with its nasal pole suture immediately adjacent to the superior pole of the medial rectus, and both sutures were passed intrasclerally in standard crossed-swords manner to place the superior rectus in line with the medial rectus, approximately equidistant from the corneal limbus. The muscle was tied securely at this location. Similarly, the left superior rectus was anteriorly transposed to the superior border of the left medial rectus muscle and sutured securely. It was clear that there was not adequate adduction of the left eye following this procedure alone, and therefore a Foster modification was applied to adjust the amount of adduction. This involved using a 5-0 Mersilene suture, which was passed through the inferior one-quarter of the transposed superior rectus muscle, 8.0 mm posterior to the insertion. The suture was then passed intrasclerally at the superior border of the left medial rectus, and the muscle was tied securely at this location. Similarly, the 5-0 Mersilene suture was passed at the same position in the left inferior rectus, 8.0 mm posterior to its insertion and through the superior quarter of the muscle. This was also attached securely with an intrascleral pass at the inferior border of the left medial rectus. This muscle was also tied securely in this position. Conjunctiva was then closed with interrupted 6-0 Vicryl suture. At conclusion of surgery, all drapes and instrumentation were removed. Betadine 5% solution, and Ofloxacin ophthalmic drops, and Xylocaine 2% gel were applied to the left eye. The patient emerged from anesthesia uneventfully and left the operating room in stable condition. _________________________ Adam D. Abroms, M.D. AA/mes D: 06/02/16 T: 06/03/16 Tracking #: WS365517 Page 2 of 2