DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right Achilles tendon rupture.
POSTOPERATIVE DIAGNOSIS: Right Achilles tendon rupture.
OPERATION PERFORMED: Open repair of right Achilles tendon using Kessler technique.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
TOURNIQUET: Right upper thigh inflated to 350 mmHg. Total time, 40 minutes.
COMPLICATIONS: None.
DISPOSITION: To recovery room.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. Ancef 1 g was given preoperatively. After satisfactory general endotracheal anesthesia was administered, a tourniquet was placed on the right upper thigh, which was well padded. The patient was then turned into the prone position. The right lower extremity was then prepped and draped in a regular sterile routine fashion.
A longitudinal incision over the medial border of the Achilles tendon was performed. The paratenon was opened. There was a hematoma and obvious complete rupture of the Achilles tendon. There was an avulsed piece of bone that was seen in the wound still attached to part of the Achilles tendon. That free fragment was sharply excised. The ends were cleaned, and the Achilles tendon was freed proximally and distally. The plantaris was found to be intact.
After cleaning the edges, #5 TiCron sutures were used in a locking fashion using Kessler technique both proximally and distally. The two free ends were then tied down as core sutures. After tying down the two core sutures, the tendon was reinforced with 0 Ethibond circumferentially. The longitudinal tendon that was still remaining was reinforced over the distal Achilles tendon.
At the completion of the repair, it was tested intraoperatively, and it was found to be a strong repair. The wound was then irrigated copiously with normal saline. The paratenon was then closed with 2-0 Vicryl, the subcutaneous with 3-0 Vicryl and the skin with 3-0 nylon. The tourniquet was deflated prior to completion of the wound closure, and hemostasis was secured. Dressing was then applied in the form of Adaptic, 4 x 4, sterile Webril and splint into an equinus position. The patient tolerated the procedure well and was taken to recovery in stable condition.
