PREOPERATIVE DIAGNOSIS: Hallux rigidus/osteoarthritis, first metatarsophalangeal joint, right foot.
POSTOPERATIVE DIAGNOSIS: Hallux rigidus/osteoarthritis, first metatarsophalangeal joint, right foot.
OPERATION PERFORMED: Cheilectomy, first metatarsophalangeal joint, right foot – Valenti procedure.
SURGEON: John Doe, MD
DESCRIPTION OF OPERATION: The patient was brought to the OR and placed on the operating table in the supine position for cheilectomy. IV was intact for IV sedation. Local anesthesia was obtained using 2% Carbocaine. The right foot was prepped and draped in the usual aseptic manner. Hemostasis was obtained using an Esmarch tourniquet to the right ankle.
Attention was directed to the dorsal aspect of the first metatarsophalangeal joint, where an 8 cm curvilinear incision was made with a medial converging semi-elliptical incision. The incision was deepened using sharp and blunt dissection techniques. Vital structures were retracted medially and laterally. Superficial vessels were cauterized. Linear capsulotomy was performed with extension over the proximal phalanx and first metatarsal and exposure was obtained to the first MPJ.
The patient had hypertrophic bone formation and clear synovitis. There was degeneration of the dorsal and lateral aspect of the first metatarsal head. Hypertrophic bone was excised using power saw, rongeur, and rasp from the dorsal, lateral, and medial aspects of the first metatarsal head. At this time, osteotomy was performed from medial to lateral in a slanted fashion to remove the prominent dorsal head of the first metatarsal.
The site was then copiously flushed using sterile saline. The bone was further remodeled using rongeur and rasp and flushed again. Deep closure was obtained using 2-0 Vicryl simple interrupted suture. Subcutaneous closure was obtained with 4-0 Vicryl mattress suture and skin closure was obtained with 4-0 Monocryl subcuticular running suture and tincture of benzoin and Steri-Strips.
Postoperatively, 0.5% Marcaine and dexamethasone were administered. The site was dressed with Adaptic, Polysporin, sterile gauze, sterile Kling, Coban, and compression dressing. Upon release of the tourniquet, the color returned to all digits of the right foot. The patient was taken to the PAR in stable condition.
The patient was given the following postoperative instructions:
1. Rest.
2. Elevation of the right leg.
3. Keep an ice bag on the right ankle while resting.
4. Keep the dressing clean, dry, and intact.
5. Walk with a surgical shoe only.
The patient was given the following prescriptions:
1. Motrin 800 mg, #30, two refills, one b.i.d. with food.
2. Lorcet 10, #20, one every six hours p.r.n. pain.
