DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Neuroma, third and fourth interspace, left foot.
POSTOPERATIVE DIAGNOSIS: Neuroma, third and fourth interspace, left foot.
PROCEDURE PERFORMED: Neurectomy, third and fourth interspace, left foot.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Approximately 10 mL.
SPECIMEN: Soft tissue neuromas were retained for gross and pathologic inspection.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old male complaining of pain associated with his left forefoot. He has been diagnosed with neuromas in the third and fourth interspace and opted for surgical correction due to failure of conservative treatments up to this point. He was advised as to all possible risks and benefits of neurectomy and agrees to it at this time by signing an informed consent.
DESCRIPTION OF PROCEDURE: The patient was brought to the OR and placed on the operating table in a supine position. After proper IV sedation and general anesthetic was initiated by the anesthesiologist, local anesthesia was accomplished using approximately 10 mL of 0.5% Marcaine in the form of a forefoot block to the left lower extremity. The patient was then aseptically prepped and draped in the usual fashion. A pneumatic cuff was then placed around his left ankle for hemostasis purposes.
After checking anesthesia, the patient was noted to be insensate, and his left foot and ankle were then exsanguinated using an Esmarch bandage. The pneumatic cuff was elevated to a level of approximately 250 mmHg.
Attention was then turned to the third interspace on the left foot where a dorsal linear incision, approximately 3 cm long, was planned and placed using sharp and dull dissection, taking care to cauterize all appropriate small vessels and preserve any neurovascular structures as indicated to the level of the deep transverse intermetatarsal ligament, which was incised between the third and fourth metatarsal heads.
This revealed a neuroma between the third and fourth metatarsal heads, which was identified at its most proximal aspect and distal aspect and resected using sharp dissection. It was saved for gross and pathologic inspection at that point.
The patient then had the wound inspected for any devitalized soft tissue or bone, none was found. The patient then had the wound copiously irrigated with normal saline. The deep soft tissue structures were reapproximated and final skin closure attained using 4-0 polypropylene suture in a running interlocking technique.
The patient then had a similar procedure performed on the fourth interspace on that left foot with no appreciable change in technique and another soft tissue sample saved for gross and pathologic inspection.
The patient then had both wounds cleansed and dressed using iodine-soaked Adaptic gauze, Kling, Kerlix, and Coban. The patient then had the pneumatic cuff deflated.
The patient tolerated the anesthesia and procedure well and left the OR for recovery with all vital signs stable and vascularity intact to the entire left lower extremity. He was instructed as to weightbearing status, which is full weightbearing with the use of postoperative shoe. He was also educated as to all signs and symptoms of infection and asked to contact the clinic if any of those signs or symptoms should manifest and will return to clinic in five days for first wound check.
