DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left second and third toe hammertoe deformity with subluxation and partial rupture of the metatarsophalangeal joint of the second toe.
POSTOPERATIVE DIAGNOSIS: Left second and third toe hammertoe deformity with subluxation and partial rupture of the metatarsophalangeal joint of the second toe.
OPERATION PERFORMED: Left second and third toe arthrodesis at the proximal interphalangeal joint with tenotomy and capsulotomy of the second and third metatarsophalangeal joint.
SURGEON: John Doe, DPM
ANESTHESIA: IV sedation with local of 15 mL of 0.5% Marcaine plain and 1% lidocaine plain.
ESTIMATED BLOOD LOSS: Minimal.
MATERIALS: A 2.0 mm Trim-It absorbable pin, 3-0 Vicryl and 5-0 nylon.
HEMOSTASIS: Left knee tourniquet at 250 mmHg for 30 minutes.
COMPLICATIONS: None.
INJECTABLES: 4 mL of 0.5% Marcaine with 1 mL of Decadron.
DRESSINGS: Betadine-soaked Adaptic, Betadine-soaked 4 x 4’s, fluffs, Kling, and Coban.
SPONGE AND NEEDLE COUNT: Correct.
DESCRIPTION OF OPERATION: Under mild sedation, the patient was brought to the operating room and placed on the operating table in the supine position. Following IV sedation and 600 mg of clindamycin, approximately 15 mL of 0.5% Marcaine plain and 1% lidocaine plain was injected about the left forefoot area. The foot was then scrubbed, prepped, and draped using an aseptic manner. The left foot was then elevated and exsanguinated, and the left ankle tourniquet was inflated to 250 mmHg.
Attention was directed to the dorsal aspect of the left second and third toe, where a 1.5 cm linear incision was made over the proximal interphalangeal joint. The incision was then deepened down to the level of the joint. A tenotomy was performed of the extensor tendon. The head of the proximal phalanx and base of the middle phalanx were resected of each toe. Due to the elongated second toe, more bone was taken from the second toe of the proximal phalanx. The toe continued to have a dorsiflexor contracture of the second metatarsophalangeal joint, so a 1 cm incision was made between the second and third metatarsals. A tenotomy of the extensor digitorum longus tendon was performed and a dorsal capsulotomy was performed allowing the toe to realign at the second metatarsophalangeal joint. A lateral release of the third metatarsophalangeal joint was also performed in order to try and correct for the lateral deviation of the third toe.
The proximal interphalangeal joints were then fixated with a 2 mm Trim-It absorbable pin. The third toe was placed in a slightly medial position and corrected for the proximal phalanx lateral deviation. Good alignment of the toes clinically and radiographically. The incision was then flushed with copious amounts of normal saline and Kantrex. The extensor tendons were reapproximated with 3-0 Vicryl. The skin was closed with 5-0 nylon. The incision site was injected with 4 mL of 0.5% Marcaine and 1 mL of Decadron and then bandaged with Betadine-soaked Adaptic, Betadine-soaked 4 x 4’s, fluffs, Kling and Coban. The left ankle tourniquet was deflated at approximately 30 minutes with prompt hyperemic response to all digits of the left foot. The patient left the OR for the PACU with vital signs stable. The patient is to remain partial weightbearing in postoperative shoe and follow up in one week.
