DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Hallux valgus deformity, left.
2. Tailor’s bunion, left.
POSTOPERATIVE DIAGNOSES:
1. Hallux valgus deformity, left.
2. Tailor’s bunion, left.
OPERATIONS PERFORMED:
1. Modified Kalish-Austin bunionectomy, left foot.
2. Reverse Austin Tailor’s bunionectomy, left foot.
SURGEON: John Doe, MD
ANESTHESIA: Local with IV sedation.
HEMOSTASIS: Ankle tourniquet at 250 mmHg.
ESTIMATED BLOOD LOSS: Less than 5 mL.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient presents for surgical correction of hallux valgus deformity, left, and Tailor’s bunion, left. After repeated unsuccessful attempts at conservative therapy, the patient requested surgical intervention at this time.
She was advised of alternative treatment options as well as advised of the possible risks and complications associated with the surgery, including infection, delayed healing, swelling, pain and numbness, recurrence or deformity, stiff toe, malunion, nonunion, hallux varus or loss of digit related to vascular or infectious process.
The patient understands these possibilities and requested modified Kalish-Austin bunionectomy and reverse Austin Tailor’s bunionectomy be performed as planned. The patient was given the opportunity to ask any questions, and all questions were answered in a satisfactory manner.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed on the table in the supine position. She received IV sedation by the anesthesia staff and was also given local anesthetic block to the left foot consisting of 2% Carbocaine. A well-padded tourniquet was placed at the level of the left ankle. The patient’s foot was prepped and draped in the usual aseptic technique. An Esmarch bandage was used to exsanguinate the foot and the tourniquet inflated to 250 mmHg, which provided adequate hemostasis throughout the entire procedure.
Attention was focused to the dorsomedial aspect of the first MPJ. A linear incision measuring approximately 5.5 cm in length was made. Incision was deepened and underscored taking care to retract all neurovascular structures and electrocoagulating bleeders as necessary. Deep dissection was continued to the level of the first metatarsophalangeal capsule. The capsule was exposed both dorsally and medially and a T capsulotomy performed. Deep dissection was continued to expose the distal first metatarsal.
Upon adequate exposure, there was found to be significant bony prominence at the medial aspect of the first metatarsal head. This bony prominence was excised in toto using a sagittal saw. The areas were rasped smooth.
A Kalish-type osteotomy was then performed. The head of the metatarsal was transposed laterally and fixated from dorsal to plantar using two right 3.0 compression screws. The resultant medial eminence was excised in toto. The area was rasped smooth. The surgical site was copiously irrigated with antibiotic solution. Lateral release of the adductor tendon was performed. A medial capsulorrhaphy was also performed at this time. The capsular structures were reapproximated using 2-0 Vicryl. The subcutaneous tissues were reapproximated using 3-0 Vicryl. The skin was reapproximated using a subcuticular suture of 4-0 Monocryl.
Attention was then focused to the lateral aspect of the foot where there was noticed to be a significant bony prominence at the lateral aspect of the fifth metatarsophalangeal joint. A dorsolateral incision over the fifth MPJ was performed measuring approximately 3.5 cm in length. The incision was deepened and underscored taking care to retract all neurovascular structures and electrocoagulating bleeders as necessary. Deep dissection was continued to the level of the fifth MPJ capsule.
A linear capsular incision was made and dissection continued to expose the head of the fifth metatarsal and base of the proximal phalanx. Upon adequate exposure, there was noticed to be a significant bony prominence of both the head of the fifth metatarsal and base of the proximal phalanx. The bony prominences were resected in toto using a sagittal saw. The area was rasped smooth.
A long arm reversed Austin osteotomy was then performed at the head of the fifth metatarsal. The head was transposed medially and fixated from dorsal distal to plantar proximal using a right 3.0 compression screw. The resultant lateral eminence was excised in toto. The area was rasped smooth. The surgical site was copiously irrigated with antibiotic solution. The capsular structures were reapproximated using 3-0 Vicryl and the subcutaneous tissue was reapproximated using 3-0 Vicryl. The skin was reapproximated using a subcuticular suture of 4-0 Monocryl.
Surgical sites were injected with Decadron. The patient was also given a postoperative local anesthetic block consisting of 0.5% plain Marcaine for prolonged anesthesia. A sterile dressing consisting of Steri-Strips, Xeroform gauze, 4 x 4s, Kling, Kerlix and Coban were applied to the left foot. Tourniquet was released and immediate capillary refill was noticed to all digits.
The patient tolerated the modified Kalish-Austin bunionectomy and reverse Austin Tailor’s bunionectomy and anesthesia well and was sent to the recovery room in good condition with vital signs stable and capillary refill to all digits of the left foot less than three seconds.
The patient was given written and verbal instructions. She was advised to call if any problems or complications arose or seek attention in the emergency room if unable to contact us. She was given a prescription for Vicodin ES 25 tablets one tablet p.o. q 4-6 hours p.r.n. for pain. X-ray, three views, left foot, to be taken postoperatively. The patient was given an appointment for one week postop. Pneumatic boot dispensed to be used as instructed. The patient will return to the office in one week for followup care or call sooner if problems arise.
