Achilles Debridement, Tenotomy or Synovectomy


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Hey Everyone,

Got a note that has me confused (or maybe I need more coffee). Since the paratenon is part of the tendon but is really synovium, is this a synovectomy, tenotomy, tendon debridement or all of the above?

Here's the note...

Description of Procedure:

Following adequate informed consent, the patient was taken to the operating room and placed in the supine position. IV sedation was administered without difficulty. Perioperative antibiotics were administered. General endotracheal anesthesia was then achieved. The patient was placed in the prone position with care taken to pad bony prominences. The left lower extremity then had a nonsterile pneumatic tourniquet placed proximally and subsequently prepped and draped in the usual sterile fashion using multiple layers of DuraPrep solution. Following draping, the leg was exsanguinated using Esmarch bandage and the tourniquet inflated to 350 mmHg.

Following tourniquet inflation, a 3-cm incision was made centered on the thickening of the Achilles tendon proper. Dissection was carried down sharply to the subcutaneous tissue. The paratenon was identified. It was thickened and inflamed and chronically scarred in the Achilles. This was dissected free of any surrounding soft tissue attachments. This was excised, around 75% of the circumference thickened of the tendon of the Achilles. The Achilles was then exposed. Longitudinal preparation was performed along the Achilles, the area of palpable nodularity. The nodules that were encountered were the areas of tenderness and degeneration. They were sharply excised using a 15-blade. The tendon was debrided to normal thickness and morphology. At this point, the wounds were thoroughly and copiously irrigated. The Achilles tendon was closed using a simple suture of 2-0 Vicryl.