DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left hallux osteomyelitis.
POSTOPERATIVE DIAGNOSIS:
Left hallux osteomyelitis.
OPERATION PERFORMED:
Left hallux amputation.
SURGEON: John Doe, DPM
ANESTHESIA:
Monitored anesthesia care with local consisting of 12 mL of 1:1 mixture of 2% lidocaine plain with 0.5% Marcaine plain injected in a nail block fashion.
HEMOSTASIS:
Left pneumatic ankle tourniquet set at 250 mmHg.
ESTIMATED BLOOD LOSS:
Less than 5 mL.
MATERIALS:
None.
INJECTABLES:
None.
COMPLICATIONS:
None.
PATHOLOGY:
Left hallux sent for culture and pathology.
DISPOSITION:
The patient tolerated the procedure and anesthesia well and was transferred to the recovery room with vital signs stable and vascular status intact to her left lower extremity. She will be monitored for a sufficient period of time before being discharged to home.
INDICATIONS FOR PROCEDURE:
The patient is a (XX)-year-old female who presented today for surgical correction for the above-mentioned deformity. The patient was admitted to the hospital with this nonhealing ulcer and cellulitis. An MRI was ordered and was positive for bone infection to her left hallux.
The patient was given various options for treatment including conservative and surgical care. The patient elected surgical treatment at this time. She is aware of the potential risks, benefits and outcomes this surgery entails. The patient has been n.p.o. since midnight. She has signed the consent form for left hallux amputation and has been medically cleared for surgery.
DESCRIPTION OF OPERATION:
Under mild IV sedation, the patient was wheeled back into the operating room and placed on the operating table in a supine position for left hallux amputation. A well-padded left pneumatic thigh tourniquet was then placed above the patient’s left leg and the above-mentioned cocktail was then injected to the left leg for anesthesia. The left foot was then scrubbed, prepped and draped in the usual aseptic manner. The foot was then elevated at approximately an angle of 60 degrees for approximately 5 minutes for exsanguination. The tourniquet was then inflated.
Attention was then directed to the dorsomedial aspect of the patient’s right foot where a racquet-type incision was made, extending distally, looping around the hallux into the first and second digital web space. The incision was made in the routine fashion, single layer down to the level of bone. When doing so, there was no purulence noted at the incision site. The incision was carried deep down to the level of the first metatarsophalangeal joint where the hallux was disarticulated at that level.
Once disarticulated, the first metatarsophalangeal joint, the hallux was removed from the operative field and placed on the back stable to be sent for pathologic analysis. The first metatarsal head was inspected and there seemed to be no clinical evidence of osteomyelitis to the first metatarsal head and no defects and no bony work was done to that at that time. Any remaining devitalizing necrotic or infected tissue was debrided as necessary.
The sesamoidal apparatus was dissected out from the slit and removed. The extensor tendon was dissected as proximally as visible and transected at that level. The operative site was then irrigated utilizing a pulse lavage, 3 liters of normal sterile saline. A small tissue culture from the remaining tissue flaps was then taken post irrigation, to be sent for culture and sensitivity analysis. Also, bleeders were bovied as necessary. Skin closure was then obtained utilizing 3-0 nylon and 4-0 nylon in combination of simple interrupted suture fashion.
The tourniquet was deflated and prompt hyperemic response was noted to the left lower extremity. At the end of the left hallux amputation, the patient was sent to recovery room with the above-mentioned disposition.
