joanne71178
Guru
POSTOP DIAGNOSIS: Multiple binions, with hammertoes one through five, with severe hallux valgus and subluxation of the metatarsal phalangeal joint of the the great toe, right foot. PROCEDURE:
1. Bunionectomy of the right great toe, with osteotomy of the proximal phalanx and Z-plasty lengthening of the extensor tendon of the great toe.
2. Excision of the metatarsal heads two through five, with Z-plasty lengthening of each extensor tendon.
DESCRIPTION:
Carefully placed medial incision across the metatarsal phalangeal joint was then carried longtudinally, care being taken to avid damage to neurovascular structures. The hallux was then carefully identified and capsular flap proximally based twas then created, with removal of the metatarsal prominence with use of a small osteotome. This was carefully carried out and an intraarticular release of the medial capsule then performed. Utilizing a small oscillating saw, after careful retraction fo the subperiosteal structures, the proximal phalanx was then osteotomized with a closing wedge osteotomy with varus positioning. This was then closed an held with fiber wire suture. The capsule was then carefully tightened with the toe in corrected position and a Z-plasty of the tightened extensor tendon was tehn carried out. Teh wound was copiously irrigated and closed with muliple sutures of 4-0 nylon.
Attention was turned to the lesser toes, in which an incision wa then made between the second and third and over the metatarsal shaft of the fith metatarsal. Careful retraction, subperiosteal resection, and use of a small oscillating saw allowed for osteotomies of the metatarsal necks of the second through fith metatarsals, with complete excision of the metatarsal heads and sequential Z-plasty lengthening of the extensor tendons. The wounds were copiously irrigated an d tourniquete released. Hemostatis was obtained with electrocautery and pressue, Marcain instilled, and wounds closed with 2-0 nylon , bulky dressing applied with toe in corrected position utilizing soft splint.
28292- 52, T5? no K-wire noted....
28294
28112 x 3; T6, T7, T8
28113 T9
Any thoughts would be much appreciated.
Thank you in advance!!