Under loupe magnification, careful dissection was performed down through the subcutaneous tissue. There was an area just proximal to the joint where the cutaneous nerve was identified. It was traced out distally, and it dove into the capsule itself, but no further distal extension was noted. This was felt to be an encapsulated neuroma of the distal portion of the nerve into the capsule. This area was then excised.
A longitudinal dorsal capsulotomy was then performed. The capsular release was performed on the dorsal, lateral, and medial surfaces. A large dorsal bunion deformity was identified. Under direct vision, and resecting approximately the dorsal 20% of the joint, the dorsal bunion was resected. After resection of the bunion, the toe could be taken into 90 degrees of dorsiflexion, and approximately 30 degrees of plantar flexion. The edges were rongeured smooth. The remainder of the articular surface was inspected, and noted to be normal.
At this point, the dissection was carried more proximal. The dorsal cutaneous nerve was identified. The incision was extended 3 cm. Blunt dissection was carried down through the subcutaneous tissue. Once again, the distal distribution of the saphenous nerve was tracing into the location of the dorsal medial cutaneous nerve was identified. There was an area here where there was a balled up scar, which appeared to be at the most proximal portion of the previous capsulotomy. Again, it did not exit out of this site. It was then dissected free, and due to its location exactly at the site of her previous Tinel's, it was sharply excised with a fresh #15 blade, after fully retracting it into the wound. At this point, the proximal area was more up around the anteromedial ankle, well within the capsule and the fat of the anteromedial foot.
28290 ???
28080 x2?????? CAN ANYONE SHARE THEIR OPINION I AM STUMPED!!!!!
A longitudinal dorsal capsulotomy was then performed. The capsular release was performed on the dorsal, lateral, and medial surfaces. A large dorsal bunion deformity was identified. Under direct vision, and resecting approximately the dorsal 20% of the joint, the dorsal bunion was resected. After resection of the bunion, the toe could be taken into 90 degrees of dorsiflexion, and approximately 30 degrees of plantar flexion. The edges were rongeured smooth. The remainder of the articular surface was inspected, and noted to be normal.
At this point, the dissection was carried more proximal. The dorsal cutaneous nerve was identified. The incision was extended 3 cm. Blunt dissection was carried down through the subcutaneous tissue. Once again, the distal distribution of the saphenous nerve was tracing into the location of the dorsal medial cutaneous nerve was identified. There was an area here where there was a balled up scar, which appeared to be at the most proximal portion of the previous capsulotomy. Again, it did not exit out of this site. It was then dissected free, and due to its location exactly at the site of her previous Tinel's, it was sharply excised with a fresh #15 blade, after fully retracting it into the wound. At this point, the proximal area was more up around the anteromedial ankle, well within the capsule and the fat of the anteromedial foot.
28290 ???
28080 x2?????? CAN ANYONE SHARE THEIR OPINION I AM STUMPED!!!!!
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