PREOPERATIVE DIAGNOSES:
1. Cellulitis, left foot.
2. Tophaceous gout, distal interphalangeal joint, third digit, left foot.
POSTOPERATIVE DIAGNOSES:
1. Cellulitis, left foot.
2. Tophaceous gout, distal interphalangeal joint, third digit, left foot.
OPERATIONS PERFORMED: DIPJ arthroplasty, third digit, left foot, with primary closure and excision of tophaceous gout.
SURGEON: John Doe, DPM
ANESTHESIA: Local anesthesia, IV sedation.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed on the operating room table in the supine position. IV was intact for IV sedation, and local anesthesia was obtained using 2% Carbocaine. The left foot was prepped and draped in the usual aseptic manner. Hemostasis was obtained using an Esmarch tourniquet on the left ankle.
Attention was directed over the dorsal aspect of the DIPJ where two converging semi-elliptical incisions were made in the transverse fashion surrounding the ulceration that presented due to an aggressive tophaceous gout attack. The incision was deepened using sharp and blunt dissection techniques. Vital structures were retracted proximally and distally. Tophaceous gout was excised and curetted and submitted for biopsy. The proximal portion of the distal phalanx was then excised as if it had been eroded due to the tophaceous gout attack. This surgical site was the copiously flushed and more tophi curetted.
At this time, deep closure was obtained using 4-0 Vicryl simple suture. The skin closure was obtained using 4-0 nylon simple interrupted suture. Postoperatively, 0.5% Marcaine was injected for postoperative anesthesia. Upon releasing the tourniquet, normal color returned to all digits of the left foot. The surgical site was then dressed with Adaptic, Polysporin, sterile gauze, sterile Kling, Kerlix, and Coban compression dressing. The patient was taken to the PAR in stable condition.
The patient was given the following postoperative instructions:
1. Rest.
2. Elevation of the left leg while resting.
3. Keep the dressing clean, dry, and intact.
4. Walk with a surgical shoe only.
PROGNOSIS: Good as far as the third toe, left foot, is concerned at this time.
We will continue the patient on Keflex as he has responded to the previous local cellulitis that began last week.
