PREOPERATIVE DIAGNOSIS: Osteomyelitis of the right fifth toe.
POSTOPERATIVE DIAGNOSIS: Osteomyelitis of the right fifth toe.
PROCEDURE PERFORMED: Amputation of right fifth toe.
SURGEON: John Doe, MD
ANESTHESIA: General anesthetic.
ESTIMATED BLOOD LOSS: 750 mL.
SPECIMEN: Right fifth toe.
COMPLICATIONS: None.
INDICATION FOR PROCEDURE: This is a (XX)-year-old male who has poorly controlled diabetes. He had a cut on his right fifth toe for some time that developed an infection and subsequently osteomyelitis. He returned to the hospital with complaints of not feeling well and drainage from his fifth toe.
X-ray confirmed osteomyelitis of the right fifth toe with destruction of the phalangeal joints. The patient had purulent drainage. It was felt that he would benefit with amputation and the patient agreed.
The procedure, risks, benefits and alternatives of amputation of right fifth toe were explained to the patient. The patient’s questions were answered, and he wished to proceed with surgery.
DESCRIPTION OF PROCEDURE: After consent was obtained for amputation of right fifth toe, the patient was taken from the preoperative holding area to the OR suite. The patient was given medication and intubated.
This right foot was prepped and draped in the usual sterile fashion. A towel clip was placed on the toe, and a 10 blade knife was then used to make an incision just at the skin at the joint level of the metatarsal and right fifth phalanx. This was then brought anteriorly and down to a V to incorporate the entire wound.
We then divided the tissue and the tendon and disarticulated the toe. We then used the periosteal elevator for the metatarsal head. Once this was free, we then used rongeurs to piecemeal remove the distal fifth metatarsal bone until we had good bone.
Once we had good bone, we stopped and smoothed the bone with the rongeurs. We used Pulsavac in the wound with 3000 mL of normal saline solution. We had good bleeding at the skin edges. We stopped the bleeding with electrocautery. We had good coverage of the bone with soft tissue and skin.
We did close a portion of the incision secondary to making a proximal incision secondary to having to get more of the bone removed. We left the rest of the wound open secondary to the purulence and active infection.
This was then packed with a wet-to-dry and followed by a Kerlix and Ace wrap. The patient was transferred to the bed in fair and stable condition and was extubated per Anesthesia. He was taken to the PACU.
