twilson@fmchosp.com
Guest
I'm not sure where to go with this one, any and all help would be much appreciated!
Dx: Contracted toe, s/p fusion
Operation: Correction of contracted second to, lt foot.
Attention was then directed to the left foot, where an Esmarch bandage was utilized to exsanguinate the patient's left foot. A pneumatic ankle tourniquet was tehn inflated. Attention was then directed to the second toes, where two converging longitudinal semi-elliptical incisions were made over the dorsal aspect of the digit. Dissection was continued through the subcutaneous tissues utilizing sharp dissection, with care being taken to identify and retract all vital neurovascular structures and all bleeders being ligated and cauterized as necessary. At this time, the are of the PIPJ was visualized. This area did appear to be fused from a previous surgery. An osteotomy was then created just distal to this fusion site. Upon completion of this osteotomy a second osteotomy was created just proximal and parallel to this site, thus creating a new joint in this area and taking the contracture off the toe. This piece of bone was removed in its entirety and passed to the back table. Dissection was continued throught this dorsal incision, dissecting out the flexor tendons. Once the flexor tendons were visualized, they were transected in thier entirety, reducing the plantarflexory pull at the tip of the toe. Correction of the deformity was assessed at this time. The wound was then flushed with copious amounts of setile normal saline. the extensor tendon was reapproximated and coated utilizing #3-0 Monocryl suture. Next, the skin was reapporximated and coated utilizing #4-0 nylon suture in a horizontal mattress and simple interrupted suture technique.
Dx: Contracted toe, s/p fusion
Operation: Correction of contracted second to, lt foot.
Attention was then directed to the left foot, where an Esmarch bandage was utilized to exsanguinate the patient's left foot. A pneumatic ankle tourniquet was tehn inflated. Attention was then directed to the second toes, where two converging longitudinal semi-elliptical incisions were made over the dorsal aspect of the digit. Dissection was continued through the subcutaneous tissues utilizing sharp dissection, with care being taken to identify and retract all vital neurovascular structures and all bleeders being ligated and cauterized as necessary. At this time, the are of the PIPJ was visualized. This area did appear to be fused from a previous surgery. An osteotomy was then created just distal to this fusion site. Upon completion of this osteotomy a second osteotomy was created just proximal and parallel to this site, thus creating a new joint in this area and taking the contracture off the toe. This piece of bone was removed in its entirety and passed to the back table. Dissection was continued throught this dorsal incision, dissecting out the flexor tendons. Once the flexor tendons were visualized, they were transected in thier entirety, reducing the plantarflexory pull at the tip of the toe. Correction of the deformity was assessed at this time. The wound was then flushed with copious amounts of setile normal saline. the extensor tendon was reapproximated and coated utilizing #3-0 Monocryl suture. Next, the skin was reapporximated and coated utilizing #4-0 nylon suture in a horizontal mattress and simple interrupted suture technique.