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PRE-OPERATIVE DIAGNOSIS: Abscess and foreign body, right foot
POST-OPERATIVE DIAGNOSIS: Abscess and foreign body, right foot
PROCEDURE(S): INCISION AND DEBRIDEMENT OF RIGHT FOOT
ANESTHESIA: General
CULTURE: Aerobic/Anaerobic culture
INDICATIONS: Patient has a 6 day history of increased redness, swelling and pain of the right foot with elevated WBC. MRI reveals at least one abscess with abnormal signal within the abscess. I&D recommended and patient agreeable to proceeding.
PROCEDURE:
The patient had the opportunity to ask any and all questions prior to the procedure. The patient was transported to the operating room and placed on the operating table in supine position. A pneumatic thigh tourniquet was applied to the right thigh. The right foot, ankle and leg were then prepped and draped in sterile fashion.
Attention was then directed to the medial right foot and ankle where a curvilinear incision was created starting at the medial heel at the level of the flexor tendons distal to the medial malleolus and carried along the abscess to the plantar medial arch. Sharp and blunt dissection carried down with pus draining throughout the dissection. Culture was taken of the pus. A tiny piece of metallic looking material was identified within the purulence and mushy, necrotic tissue and this was sent to pathology to try to confirm/identify the presence of suspected foreign body. Purulence continued to be expressed from proximal and the flexor retinaculum was transected with care taken to protect the underlying neurovascular and tendinous structures and no further pus was then found proximally. The abscess tract was followed distally through the plantar arch laterally to where a scab is located from a previous burn. The abscess doesn't however connect to the scab. Once this plane was followed and milked, no further pus identified. Additional purulence was noted from the medial foot and an additional abscess/additional tract was identified coursing along the abductor hallucis muscle starting at the medial heel at the level of the muscle origin and extending to the medial midfoot where a 1 cm incision was created. A hemostat was utilized to connect/follow the tracts and the abscess had extended along the abductor hallucis tendon. A curette was utilized to clean any remaining debris from the abscess tract. Any remaining devitalized tissue in the operative sites was excised utilizing rongeur and curette. The operative site and abscess tracts were flushed with 3L of normal sterile saline with gravity assisted cystotubing.
The tracts were packed with packing strip and fluffs and dressed with 4x4s, ABD pad, kerlix and ace wrap.
The patient tolerated the anesthesia and procedure well and was transported to PACU with vital signs stable and vascular status intact.
POST-OPERATIVE DIAGNOSIS: Abscess and foreign body, right foot
PROCEDURE(S): INCISION AND DEBRIDEMENT OF RIGHT FOOT
ANESTHESIA: General
CULTURE: Aerobic/Anaerobic culture
INDICATIONS: Patient has a 6 day history of increased redness, swelling and pain of the right foot with elevated WBC. MRI reveals at least one abscess with abnormal signal within the abscess. I&D recommended and patient agreeable to proceeding.
PROCEDURE:
The patient had the opportunity to ask any and all questions prior to the procedure. The patient was transported to the operating room and placed on the operating table in supine position. A pneumatic thigh tourniquet was applied to the right thigh. The right foot, ankle and leg were then prepped and draped in sterile fashion.
Attention was then directed to the medial right foot and ankle where a curvilinear incision was created starting at the medial heel at the level of the flexor tendons distal to the medial malleolus and carried along the abscess to the plantar medial arch. Sharp and blunt dissection carried down with pus draining throughout the dissection. Culture was taken of the pus. A tiny piece of metallic looking material was identified within the purulence and mushy, necrotic tissue and this was sent to pathology to try to confirm/identify the presence of suspected foreign body. Purulence continued to be expressed from proximal and the flexor retinaculum was transected with care taken to protect the underlying neurovascular and tendinous structures and no further pus was then found proximally. The abscess tract was followed distally through the plantar arch laterally to where a scab is located from a previous burn. The abscess doesn't however connect to the scab. Once this plane was followed and milked, no further pus identified. Additional purulence was noted from the medial foot and an additional abscess/additional tract was identified coursing along the abductor hallucis muscle starting at the medial heel at the level of the muscle origin and extending to the medial midfoot where a 1 cm incision was created. A hemostat was utilized to connect/follow the tracts and the abscess had extended along the abductor hallucis tendon. A curette was utilized to clean any remaining debris from the abscess tract. Any remaining devitalized tissue in the operative sites was excised utilizing rongeur and curette. The operative site and abscess tracts were flushed with 3L of normal sterile saline with gravity assisted cystotubing.
The tracts were packed with packing strip and fluffs and dressed with 4x4s, ABD pad, kerlix and ace wrap.
The patient tolerated the anesthesia and procedure well and was transported to PACU with vital signs stable and vascular status intact.