Hand trauma

# OPERATION NOTE — Hand trauma

Date: 19/05/2026    Acute
Surgeon: Mateusz Gładysz, Consultant Plastic and Hand Surgeon
Assistant: [Registrar Dr ____]
Anaesthetist: [Dr ____]    Anaesthetic: Supraclavicular block
WHO Surgical Safety Checklist: Sign-in / Time-out / Sign-out — completed.
ACC45 #: [#########] — mechanism: [____].

## Diagnosis / Indication

- Hand wound of [SITE] from [mechanism]; tetanus status up-to-date.
- No underlying tendon, nerve, or vessel injury confirmed clinically and intra-operatively.

## Consent

Risks discussed: bleeding, infection, scar, sensory change; need for further surgery; ongoing hand therapy. ACC funding discussed.

## Position / Anaesthesia / Tourniquet

Supine, arm on hand table. Supraclavicular block. Upper arm tourniquet 250 mmHg, on [HH:MM] off [HH:MM] = [MM] min. Tourniquet 250 mmHg, on [HH:MM] off [HH:MM] = [MM] min.

## Antibiotics

Cefazolin 2 g IV at induction (1 g if <80 kg).

## Procedure

1. Wound extended with Bruner zig-zag incision.
2. Neurovascular bundles identified and protected.
3. Pulsed lavage with 1 L warmed normal saline; foreign body sought; necrotic / devitalised tissue debrided sharply.
4. Tourniquet down; haemostasis; final irrigation.
5. Skin closed with 5-0 nylon interrupted, edges everted.
6. Non-adherent dressing + volar splint as required.

## Findings

- Clean wound at [SITE]; viable edges.

## Estimated blood loss

<10 mL.

## Complications

Nil intra-operative.

## Count

Swabs / needles / instruments — confirmed correct.

## Post-op plan

- Wound check at 48 h with GP or Plastics dressings clinic; elevation.
- Analgesia: paracetamol + NSAID + oxycodone PRN.
- No prophylactic antibiotics (clean mechanism, presented <6 h).
- ACC claim lodged.
- Clinic review at 1 week, 6 weeks.

## Signature

Mateusz Gładysz, Consultant Plastic and Hand Surgeon — 19/05/2026