ksb0211
Guest
A bit frustrated and second guessing myself. I do not regularly code out amputations, and when I do they seem to be a bit more straight-forward. I'm hoping for some suggestions.
PREOPERATIVE DIAGNOSIS
Gangrene, left foot.
PROCEDURE
Guillotine amputation of left forefoot at phalangeal transmetatarsal level.
ANESTHESIA
General.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with Betadine and draped sterilely. The patient had improvement of the erythema, but still some drainage and odor to all of the toes on the left side. The process extended into the proximal phalanx and close to the metatarsal in some areas. The incision was made just at the base of the web space with a #15 blade, carried down to subcutaneous tissue, all tendons were cut. The plantar aspect was similarly incised. Then, utilizing the Stryker saw, I was able to amputate all of the bones. This was through the proximal phalanx of the great toe and then approached the metatarsal head of the other joints. All of this was passed off as specimen. Hemostasis was achieved with electrocautery as well as suture ligatures of 3-0 Vicryl. With all of this completed, a gentamicin soaked antibiotic gauze was placed, the foot was wrapped in gauze. The patient tolerated the procedure. The patient will have intravenous antibiotics as well as wound care over the next few days with plan for close amputation in the near future. Discussed previously with patient.
Then, 5 days later:
PREOPERATIVE DIAGNOSIS/POSTOPERATIVE DIAGNOSIS
History of gangrene, left forefoot.
OPERATION PERFORMED
Revision of forefoot amputation to closed transmetatarsal amputation.
ANESTHESIA
General.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with Betadine and draped sterilely. The open wound was starting to granulate well. No purulence was appreciated.
The planned skin incision was made to completely resect the exposed tissue and take back the forefoot to the transmetatarsal level. The incision was carried down through the subcutaneous tissues. The plantar flap was developed. All tendons were cut. Once this was done, the periosteal elevator was utilized and the metatarsals were exposed. The Stryker saw was then utilized and all of the metatarsals were divided. Hemostasis was achieved with electrocautery as well as suture ligatures of 3-0 Vicryl. The 5th metatarsal was further resected utilizing the rongeur. Bone wax was utilized as necessary. With all of this completed, the wound was thoroughly irrigated with antibiotic solution. Good hemostasis had been achieved. All tendons were resected. The plantar flap was then brought cephalad with 3-0 Vicryl suture. The skin was reapproximated with interrupted 4-0 nylon. A dry sterile dressing was applied. The patient tolerated the procedure.
I appreciate any and all suggestions and/or information. Thanks.
PREOPERATIVE DIAGNOSIS
Gangrene, left foot.
PROCEDURE
Guillotine amputation of left forefoot at phalangeal transmetatarsal level.
ANESTHESIA
General.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with Betadine and draped sterilely. The patient had improvement of the erythema, but still some drainage and odor to all of the toes on the left side. The process extended into the proximal phalanx and close to the metatarsal in some areas. The incision was made just at the base of the web space with a #15 blade, carried down to subcutaneous tissue, all tendons were cut. The plantar aspect was similarly incised. Then, utilizing the Stryker saw, I was able to amputate all of the bones. This was through the proximal phalanx of the great toe and then approached the metatarsal head of the other joints. All of this was passed off as specimen. Hemostasis was achieved with electrocautery as well as suture ligatures of 3-0 Vicryl. With all of this completed, a gentamicin soaked antibiotic gauze was placed, the foot was wrapped in gauze. The patient tolerated the procedure. The patient will have intravenous antibiotics as well as wound care over the next few days with plan for close amputation in the near future. Discussed previously with patient.
Then, 5 days later:
PREOPERATIVE DIAGNOSIS/POSTOPERATIVE DIAGNOSIS
History of gangrene, left forefoot.
OPERATION PERFORMED
Revision of forefoot amputation to closed transmetatarsal amputation.
ANESTHESIA
General.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with Betadine and draped sterilely. The open wound was starting to granulate well. No purulence was appreciated.
The planned skin incision was made to completely resect the exposed tissue and take back the forefoot to the transmetatarsal level. The incision was carried down through the subcutaneous tissues. The plantar flap was developed. All tendons were cut. Once this was done, the periosteal elevator was utilized and the metatarsals were exposed. The Stryker saw was then utilized and all of the metatarsals were divided. Hemostasis was achieved with electrocautery as well as suture ligatures of 3-0 Vicryl. The 5th metatarsal was further resected utilizing the rongeur. Bone wax was utilized as necessary. With all of this completed, the wound was thoroughly irrigated with antibiotic solution. Good hemostasis had been achieved. All tendons were resected. The plantar flap was then brought cephalad with 3-0 Vicryl suture. The skin was reapproximated with interrupted 4-0 nylon. A dry sterile dressing was applied. The patient tolerated the procedure.
I appreciate any and all suggestions and/or information. Thanks.