# percutaneous tendo-achilles lengthening/ arthroereisis



## KELLI (Aug 5, 2011)

Can some one take a look at this for me I am not sure if I should be coding 28899 and 27686 x3 ?? I could use some advice on this one  Thank you


PREOPERATIVE DIAGNOSES:
1.  Severe gastrocsoleus equinus right foot.
2.  Severe flat foot deformity with subtalar joint subluxation, right
foot.

POSTOPERATIVE DIAGNOSES:
1.  Severe gastrocsoleus equinus right foot.
2.  Severe flat foot deformity with subtalar joint subluxation, right
foot.

PROCEDURE PERFORMED:
1.  Percutaneous tendo-Achilles lengthening, right foot.
2.  Subtalar joint arthroereisis right foot.


OPERATIVE FINDINGS: There is -5 to -10 degrees dorsiflexion available
at the ankle joint with a foot in the neutral position and the knee
extended.  There was approximately 5 degrees with the knee flexed.
Complete lateral trans-positioning of the peri-talar complex was
noted.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating
room and placed on the operating table in the supine position.
Anesthesia was then achieved with an LMA and local infiltration 0.5%
Marcaine plain.  The right foot and ankle were prepped and draped in
the standard orthopedic isolation technique.  Tourniquet was not
applied.  The right foot and ankle were then prepped and draped.

Next, percutaneous tendo-Achilles' lengthening incisions were planned
out.  One distal medial, one proximal medial, and one central lateral
all on the Achilles' tendon with approximately 2 centimeters between
each incision.  Percutaneous lengthening was noted by a hemisection
of all three areas with a fresh #11 blade.  Intraoperative findings
were noted to be approximately 15 degrees of dorsiflexion.  The
wounds were then irrigated and closed with 4-0 Prolene.

Next the lateral aspect of the foot was identified.  The sinus tarsi
was identified.  A small 1-cm incision was mapped and carried out
using a fresh #15 blade and the  _______intentionalized.  Blunt
dissection was carried down to the level of the sinus tarsi.  Next, a
pin from the Arthrex subtalar joint Arthrosis set was placed across
sinus tarsi and cut medially to the pin exit.  Excellent position was
noted via intraoperative fluoroscopy. Next, a #8 sizer was
introduced.  Next a #9 sizer was introduced.  This gave him
approximately 2 degrees of valgus.  There was mild forefoot
supraspinatus, approximately 3-4 degrees of inversion of the forefoot
relative to rearfoot.

At this point a #9 implant was then placed from lateral to medial.
No mid tarsal joint instability was noted.  Position was verified via
intraoperative fluoroscopy.  Excellent position was noted.
Instrumentation was removed.  Incision site was then closed using 4-0
Prolene.  Adaptic and dry sterile gauze and Coban were applied.
Next, the preop vascular status returned.  Patient was then placed in
a below the knee cast that was well padded.  Patient was then
transported to PACU with all vital signs stable and neurovascular
status intact to the right foot.
The patient tolerated the above procedure as well as anesthesia well,
was given all postoperative prescriptions and all instructions.  Will
follow up with us on Tuesday, call if any problems develop sooner.


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