Could someone please help with this one and give me your opinion?
OPERATION PERFORMED: Resection of destructing tophi from the right first metatarsophalangeal joint and first tarsometatarsal joint with synovectomy of the first metatarsophalangeal joint and release of the abductor tendon of the first metatarsophalangeal joint
OPERATION PROCEDURAL DETAILS: Under general anesthesia and supine position, we started with a medial incision over the first metatarsophalangeal joint where there was 4 x 4 cm destructing tophi on the medial side of the joint. Therefore, blunt release and the tophi could be followed to the joint which was destroying the base of the phalanx and also the head of the metatarsal and attacking the flexor tendon and also the sesamoid bone, but the tendon itself was intact and the extensor tendon was intact. The medial collateral ligament was not there and clearly destruction from the aggressive big tophi. Therefore, complete arthrotomy and two cysts, one in the head of the first metatarsal and the other one in the base of the proximal phalanx, were evacuated with a small curette and after that removal of the osteophyte from the head of the first metatarsal (Bunienectomy) Then, approached to the lateral side for release of the adductor tendon which was attached to the proximal phalanx because of the lateral deviation of the joint after removal of the big tophi. After that, neutralization of the position of the first Toe. Complete synovectomy and the joint condition was not optimal but we will give the patient a chance as we did not have an agreement with the patient about arthrodesis of the first metatarsophalangeal joint.
Irrigation with water and removal of all small tophi as much as we could and then closure in the subcutaneous tissue as there was no capsule remnant and there was no sign of any ligament remnant. Closure of the skin with #4-0 Nylon. Closure over the lateral approach to the metatarsophalangeal joint for tenolysis with #4-0 Nylon. Then, another approach over the first tarso-metatarsal joint between the first metatarsal and the cuneiform bone. Another 2 x 2 destroying tophi was identified and released from the extensor tendon and the cutaneous nerve was also recognized and respected. Then, the gout tophi were followed down to the joint and there was clear destruction of the base of the first metatarsal and also head of the medial cuneiform bone. Therefore, arthrotomy and removal of the osteophyte with a nibbler.
OPERATION PERFORMED: Resection of destructing tophi from the right first metatarsophalangeal joint and first tarsometatarsal joint with synovectomy of the first metatarsophalangeal joint and release of the abductor tendon of the first metatarsophalangeal joint
OPERATION PROCEDURAL DETAILS: Under general anesthesia and supine position, we started with a medial incision over the first metatarsophalangeal joint where there was 4 x 4 cm destructing tophi on the medial side of the joint. Therefore, blunt release and the tophi could be followed to the joint which was destroying the base of the phalanx and also the head of the metatarsal and attacking the flexor tendon and also the sesamoid bone, but the tendon itself was intact and the extensor tendon was intact. The medial collateral ligament was not there and clearly destruction from the aggressive big tophi. Therefore, complete arthrotomy and two cysts, one in the head of the first metatarsal and the other one in the base of the proximal phalanx, were evacuated with a small curette and after that removal of the osteophyte from the head of the first metatarsal (Bunienectomy) Then, approached to the lateral side for release of the adductor tendon which was attached to the proximal phalanx because of the lateral deviation of the joint after removal of the big tophi. After that, neutralization of the position of the first Toe. Complete synovectomy and the joint condition was not optimal but we will give the patient a chance as we did not have an agreement with the patient about arthrodesis of the first metatarsophalangeal joint.
Irrigation with water and removal of all small tophi as much as we could and then closure in the subcutaneous tissue as there was no capsule remnant and there was no sign of any ligament remnant. Closure of the skin with #4-0 Nylon. Closure over the lateral approach to the metatarsophalangeal joint for tenolysis with #4-0 Nylon. Then, another approach over the first tarso-metatarsal joint between the first metatarsal and the cuneiform bone. Another 2 x 2 destroying tophi was identified and released from the extensor tendon and the cutaneous nerve was also recognized and respected. Then, the gout tophi were followed down to the joint and there was clear destruction of the base of the first metatarsal and also head of the medial cuneiform bone. Therefore, arthrotomy and removal of the osteophyte with a nibbler.