DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Gas gangrene, left foot.
2. Severe peripheral vascular disease, left.
3. Necrotic full-thickness ulceration to bone, plantar, left heel.
POSTOPERATIVE DIAGNOSES:
1. Gas gangrene, left foot.
2. Severe peripheral vascular disease, left.
3. Necrotic full-thickness ulceration to bone, plantar, left heel.
4. Osteomyelitis, left calcaneus.
PROCEDURE PERFORMED:
Incision and drainage with debridement of necrotic soft tissue and bone, left foot.
SURGEON: John Doe, MD
ANESTHESIA: Spinal.
HEMOSTASIS: None.
ESTIMATED BLOOD LOSS: 20 mL.
CONSENT: After risks and benefits of the surgery were discussed with the patient, all of his questions were answered and he wished to proceed. Proper informed consent was obtained.
DESCRIPTION OF OPERATION: The patient was placed on the operating room table in the supine position. A spinal anesthesia was administered by the anesthesia staff. The left lower extremity was scrubbed and draped sterilely.
Utilizing a #15 blade, the plantar necrotic ulceration was circumscribed down to the level of bone and removed and passed from the operative field. A portion of this was sent to pathology for identification. There was severe malodor and extensive purulence. A fresh #15 blade was utilized to resect all margins down to what appeared to be fresh granular tissue. It must be noted that due to the severe peripheral vascular disease, it was not possible to resect to healthy bleeding tissue. The resection was performed to the best clinical layer possible without the advantage of having bleeding tissue.
The bone was noted to be soft at the plantar calcaneus. A fresh rongeur was utilized to resect bone from the calcaneus, and it was also sent for culture and sensitivity separately. As the necrotic tissues and liquefaction necrosis extended distally, a full-thickness linear incision was made extending from the large wound distally in a curvilinear fashion approximately 4 cm. Additionally, necrotic and liquefaction necrotic tissue was resected until what appeared to be healthy pink granular base was noted. Once again, it must be noted that due to the severe peripheral vascular disease, fresh bleeding could not be relied upon to identify the viable layers. The wound was flushed with a copious amount of sterile normal saline with added Kantrex solution, 3 liter pulse lavage. The wound was loosely packed and dressed with gauze, ABDs, Kerlix and Ace.
The patient tolerated the procedure and anesthesia well and was transferred to the recovery room in apparent satisfactory condition with vital signs stable. Vascular status as known prior to the procedure was very poor. The patient will remain in-house where he will be followed by Vascular Surgery to determine whether a revascularization is possible and warranted versus a below-knee amputation.
