DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Hallux abductovalgus, right foot.
POSTOPERATIVE DIAGNOSIS: Hallux abductovalgus, right foot.
PROCEDURE PERFORMED: Austin bunionectomy with first metatarsal osteotomy with internal screw fixation, right foot.
SURGEON: John Doe, DPM
ANESTHESIA: MAC with local.
HEMOSTASIS: Pneumatic ankle tourniquet.
ESTIMATED BLOOD LOSS: Minimal.
DESCRIPTION OF OPERATION: The patient was placed on the operating room table in the supine position. Following intravenous sedation, a Mayo block was performed using 15 mL of 0.5% Marcaine plain. A tourniquet was placed about the well-padded right ankle. The right lower extremity was scrubbed and draped sterilely. An Esmarch was utilized for exsanguination, and the pneumatic tourniquet was inflated to 250 mmHg.
A 5 cm curvilinear incision centered over the first metatarsal head was made medial to the EHL tendon. After dissecting through the subcutaneous layer with care being taken to identify and retract all vital neurovascular structures, the fibular sesamoid was freed laterally, distally, and proximally. The adductor hallucis tendon was transected, and the sesamoid apparatus was noted to float into a more corrected position.
After a linear capsulotomy, the periosteum and capsule were freed medially and laterally. The medial prominence was resected with a sagittal saw. After placement of an access guidewire, a chevron osteotomy was performed through the first metatarsal head from medial to lateral with the apex pointed distally.
A K-wire from the Depuy FRS set was used for temporary fixation across the osteotomy from dorsal proximal to plantar distal. Following AO principles and techniques, a cannulated 20 mm FRS screw was inserted over the K-wire and excellent compression was noted. The K-wire was removed. Both intraoperative evaluation and fluoroscopy was obtained to verify the position and length of the screw and the correction of the deformity, which was noted to be excellent.
The medial bone shelf was resected and rough edges were then smoothed with a power rasp. A medial capsulorrhaphy was performed. Irrigation with normal saline solution was performed. The medial capsule was reapproximated utilizing 3-0 Ethibond. The dorsal periosteum and capsule were closed with 3-0 Vicryl. The subcutaneous layer was reapproximated with 4-0 Vicryl and the skin closed with 4-0 Monocryl. Benzoin and Steri-Strips were applied to reinforce the skin closure.
The incision was dressed with dilute Betadine-soaked Adaptic, dilute Betadine-soaked gauze, gauze, Kling, Kerlix, and Coban. The pneumatic tourniquet was deflated and a prompt hyperemic response was noted to all digits of the right foot. The patient tolerated the procedure and anesthesia well and was transferred to the recovery room in apparent satisfactory condition with vital signs stable and vascular status intact.
Postoperative instructions were provided to the patient, which included partial weightbearing of the right foot with surgical shoe and crutch assistance, ice to the level of the ankle, 20 minutes on, 20 minutes off during waking hours, and elevation of the right lower extremity above the level of the heart.
