DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right Achilles tendon rupture.
POSTOPERATIVE DIAGNOSIS: Right Achilles tendon rupture.
PROCEDURE PERFORMED: Right Achilles tendon repair.
SURGEON: John Doe, MD
ANESTHESIA: Regional to include popliteal and femoral nerve blocks.
TOURNIQUET TIME: 55 minutes at 275 mmHg.
ESTIMATED BLOOD LOSS: Less than 5 mL.
DRAINS: None.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was taken to the operating room, and after regional anesthesia was administered by the anesthesia team, the patient was positioned on the operating room table in a prone position. Of note, preoperative antibiotics were given. The right ankle was prescrubbed with Betadine. Next, a tourniquet was placed high on the right thigh, and the right lower extremity was prepped and draped in the usual sterile fashion. The tourniquet was inflated to 275 mmHg after Esmarch wrapping.
After bony palpation, a longitudinal curvilinear incision was made over the posteromedial aspect of the ankle extending along the calcaneus on the medial side. This was used in case transosseous tunnels were needed for harvest and flexor digitorum longus was needed. Significant calcification was identified and Achilles tendon represented calcific tendonopathy. A rupture of the Achilles tendon was identified. There was still a stump of the Achilles tendon on the medial aspect of the calcaneus. A #5 FiberWire was placed through the proximal tendon and attempts were made to pull this to the calcaneus.
Inspection demonstrated that this could not be performed with adequate shortening. It was therefore felt that this was not a complete avulsion from the calcaneus itself. A #5 FiberWire was placed in the distal stump, and this was then repaired in a Tajima fashion. A 0 Vicryl was also used in a running fashion to help oversew the tendon itself. The wound was then liberally irrigated with normal saline solution. Hematoma was evacuated by milking the calf. The foot now could be plantar flexed to neutral position without stress on the Achilles repair. The paratenon was then closed with 2-0 Vicryl in a simple interrupted fashion. It was noted that the nature of the tendon itself as well as the quality of the tissue made the paratenon closure tenuous. This was finally performed after elevation of the skin, both medially and laterally. Care was taken to perform this sharply with a 15 scalpel blade. Minimal retraction was performed to help prevent skin breakdown postoperatively.
The wound was again liberally irrigated with normal saline solution. Subcutaneous tissue was closed with 2-0 Vicryl in a simple interrupted fashion, and the skin was closed with 4-0 Monocryl in a running subcuticular pull-out stitch. All sponge and instrument counts proved to be correct and estimated blood loss was less than 5 mL. The wound was then cleaned, steri-stripped and dressed under the sterile field. The tourniquet was deflated, and estimated tourniquet time was 55 minutes. The posterior plaster splint was applied. The patient was placed in the prone position and taken to the recovery room in a stable condition. Exam in the recovery room revealed that capillary refill of all digits was less than 1 second; however, due to regional anesthesia, neurologic exam could not be completely performed.
