Wiki started a tendon transfer but FHL tendon but decided to reattached Achilles tendon

Create Wiki Sort by date
L

lsilbaugh

Networker
Messages
38
Location
Beaver Falls, PA
Best answers
0
If anyone could provide insight on how to code this, thatd be so helpful. Provider chose 27680 and 28118.

Attention was directed to posterior aspect of the right ankle. A linear incision was made with a 15 blade over the central portion of the distal Achilles tendon to the insertion. Incision was deepened with sharp and blunt dissection to the level of Achilles tendon. The paratenon was gently reflected from the Achilles tendon. A 15 blade was then utilized to transect the Achilles at the distal aspect of the insertion, the Achilles tendon was then reflected off of the calcaneus.A large posterior calcaneal enthesophyte was noted. The sagittal saw was utilized to make a partial ostectomy of the calcaneus. The Haglund's deformity and posterior spurs were removed with a sagittal saw. The calcaneus was then gently contoured with the sagittal saw and a bur. Fluoroscopy was utilized to ensure all deformity of the posterior calcaneus had been removed. The incision was then copiously flushed with saline.

Attention was then redirected to the Achilles tendon. The tendon appeared thickened, so it was retracted out of the way. Blunt dissection was utilized to find the deep fascia overlying the flexor hallucis longus tendon. The fascia was incised with a 15 blade and reflected. The flexor hallucis longus tendon was identified and dissected from surrounding soft tissue. The flexor hallucis longus tendon was then inspected. The FHL tendon was noted to be very small in diameter, and flattened. The FHL tendon had a very low-lying muscle belly. The decision was made that the FHL tendon could not be used for transfer due to the size and quality of the tendon being to poor for transfer. It was decided to proceed with reattachment of the Achilles tendon. Tenolysis of the Achilles tendon was removed utilizing a 15 blade to sharply excise surrounding calcified and inflamed tissue from the tendon.Less than 50% of the Achilles tendon, removing all calcifications from within the distal aspect of the tendon. Next, 2 Stryker suture anchors were inserted into the dorsal aspect of the posterior calcaneus according to manufacture instruction. A free needle was then utilized to pass the suture through the Achilles tendon. Next, the sutures were crossed and anchored into the posterior calcaneus with biotenodesis screws under proper tension. Following reattachment, Achilles was noted to be properly tension with the ankle slightly plantar flexed.
 
0
amyjph said:
Was anything else done during the case?
Need the whole (redacted) op note with headers.
Click to expand...
Postoperative Diagnosis:
1. Haglund's deformity, right
2. Achilles tendinosis, right
3. Achilles insertional calcification, right
Procedure(s) Performed:
1. Achilles tenolysis, right
2. Calcaneal ostectomy, right

Findings: Large posterior calcaneal enthesophyte noted. Following partial ostectomy, posterior calcaneus was smooth and rounded. Upon incision Achilles was noted to be thickened and partially calcified. The flexor hallucis longus tendon was examined to attempt for tendon transfer, however the FHL tendon wishes flattened with a very low-lying muscle belly, and a very small diameter of tendon. Following debridement of Achilles tendon, less than 50% was debrided and decision was made to proceed with reattachment of Achilles tendon. Following reattachment, Achilles was under proper tension.

Implants:
Stryker suture anchor x2
Stryker knotless suture tack x2
Stryker biotenodesis anchor x2
Matrix graft jacket

Patient has had posterior right ankle pain for quite some time. Pain was consistent with Achilles tendinosis and Haglund's deformity. Patient has failed outpatient conservative therapy including immobilization, physical therapy, and shoe gear modification. All benefits and risks were discussed with patient at length and patient was consented for reduction of Haglund's deformity, Achilles tendon debridement, and possible FHL tendon transfer.

Operative Technique:
Patient was placed under general anesthesia. Pneumatic thigh tourniquet was placed at the right thigh. The right lower extremity was scrubbed, prepped, and draped in the usual aseptic manner. The foot and leg were exsanguinated with an esmarch and the tourniquet was inflated to 350 mm Hg. Attention was directed to posterior aspect of the right ankle. A linear incision was made with a 15 blade over the central portion of the distal Achilles tendon to the insertion. Incision was deepened with sharp and blunt dissection to the level of Achilles tendon. The paratenon was gently reflected from the Achilles tendon. A 15 blade was then utilized to transect the Achilles at the distal aspect of the insertion, the Achilles tendon was then reflected off of the calcaneus.

A large posterior calcaneal enthesophyte was noted. The sagittal saw was utilized to make a partial ostectomy of the calcaneus. The Haglund's deformity and posterior spurs were removed with a sagittal saw. The calcaneus was then gently contoured with the sagittal saw and a bur. Fluoroscopy was utilized to ensure all deformity of the posterior calcaneus had been removed. The incision was then copiously flushed with saline. Attention was then redirected to the Achilles tendon. The tendon appeared thickened, so it was retracted out of the way. Blunt dissection was utilized to find the deep fascia overlying the flexor hallucis longus tendon. The fascia was incised with a 15 blade and reflected. The flexor hallucis longus tendon was identified and dissected from surrounding soft tissue. The flexor hallucis longus tendon was then inspected. The FHL tendon was noted to be very small in diameter, and flattened. The FHL tendon had a very low-lying muscle belly. The decision was made that the FHL tendon could not be used for transfer due to the size and quality of the tendon being to poor for transfer. It was decided to proceed with reattachment of the Achilles tendon.

Tenolysis of the Achilles tendon was removed utilizing a 15 blade to sharply excise surrounding calcified and inflamed tissue from the tendon.
Less than 50% of the Achilles tendon, removing all calcifications from within the distal aspect of the tendon.

Next, 2 Stryker suture anchors were inserted into the dorsal aspect of the posterior calcaneus according to manufacture instruction. A free needle was then utilized to pass the suture through the Achilles tendon. Next, the sutures were crossed and anchored into the posterior calcaneus with biotenodesis screws under proper tension. Following reattachment, Achilles was noted to be properly tension with the ankle slightly plantar flexed.

Matrix graft jacket was then placed over the re-attached Achilles tendon. A knotless suture tack was inserted according to manufacture instruction on either side of the insertion of the Achilles. The suture was then passed to the matrix graft jacket and knotted according to manufacture instruction. The proximal aspect of the graft was attached the Achilles tendon with 2-0 Vicryl.

At this time, the tourniquet was dropped and prompt hyperemic response was noted to the digits. The incision was then copiously flushed with saline. Platelet rich plasma was injected around the Achilles tendon. The incision was closed with 2-0 Vicryl, 4-0 Monocryl, and 3-0 nylon. 20 cc of 1:1 mix of 0.5% Marcaine plain and Exparel was in injected as a postoperative block. The incision was dressed with jump-start, 4x4s, Webril, and Ace. The right lower extremity was then placed in a well-padded posterior splint in a slightly plantar flexed position.

Patient tolerated the procedure and anesthesia well. The patient was transferred to the PACU with stable vital signs. After a period of postoperative monitoring, the patient will be discharged home. The patient will be non-weightbearing to the right foot.
 
You must log in or register to reply here.
Top