Bernadette10
Guru
I'm thinking 28080 since the notes says there were branches that were "transected," but it doesn't say excised, so I'm not sure if excision is what he meant.
Preop and postoperative diagnoses: RT foot 1st and 3rd web space neuromas
Procedure: Exploration and excision of neuromas, 1st and 3rd web spaces, RT foot
Operative procedure:
After the patient received general anesthesia, intermetatarsal blocks were performed. The longitudinal incision was made in the 1st dorsal web space from the web itself and and carried proximally 2.5 cm. Gentle disssection was carried down through the soft tissues. There was a nest of vessels distally. The nerves were traced distally to the neuromatous tissue, and neurolysis was performed proximally. The soft tissue distally with the neuroma was dissected free, and there were multiple branches into this mass which were transected. In the process the dorsal intermetatarsal ligament was transected to free the nerves from above. Hemostasis was achieved with bipolar electrocautery. The wound was copiously irrigated.
Similar incision was then made in the 3rd dorsal web space, 2 cm in length. Gentle dissection was carried, and the transverse metatarsal ligament was released to visualize the nerves involved. The nerves were traced proximally and transected. The distal tissue was dissected free with further branches radiating into the mass, and these were transected, and the soft tissue was removed. Hemostasis was achieved with bipolar electrocautery. The wound was copiously irrigated.
The skin was tied wit simple suture from proximal to distal. Excellent apposition was achieved, and both of these were reinforced with 3 or 4 staples followed by Dermabond followed by 4x4s, Ace wraps. All toes were pink following this.
Preop and postoperative diagnoses: RT foot 1st and 3rd web space neuromas
Procedure: Exploration and excision of neuromas, 1st and 3rd web spaces, RT foot
Operative procedure:
After the patient received general anesthesia, intermetatarsal blocks were performed. The longitudinal incision was made in the 1st dorsal web space from the web itself and and carried proximally 2.5 cm. Gentle disssection was carried down through the soft tissues. There was a nest of vessels distally. The nerves were traced distally to the neuromatous tissue, and neurolysis was performed proximally. The soft tissue distally with the neuroma was dissected free, and there were multiple branches into this mass which were transected. In the process the dorsal intermetatarsal ligament was transected to free the nerves from above. Hemostasis was achieved with bipolar electrocautery. The wound was copiously irrigated.
Similar incision was then made in the 3rd dorsal web space, 2 cm in length. Gentle dissection was carried, and the transverse metatarsal ligament was released to visualize the nerves involved. The nerves were traced proximally and transected. The distal tissue was dissected free with further branches radiating into the mass, and these were transected, and the soft tissue was removed. Hemostasis was achieved with bipolar electrocautery. The wound was copiously irrigated.
The skin was tied wit simple suture from proximal to distal. Excellent apposition was achieved, and both of these were reinforced with 3 or 4 staples followed by Dermabond followed by 4x4s, Ace wraps. All toes were pink following this.