twalls
Networker
Procedures:
1. Lapidus fusion, left.
2. Bunionectomy with Akin osteotomy, left.
3. Osteotomy of shortened left 2nd metatarsal.
4. Arthroplasty, left 2nd toe.
Description Of Procedure:
The patient was brought to the operating room and placed on the
table in supine position. General anesthetic was provided by
the Anesthesia Department. I administered the ankle block. The
left foot and ankle were prepped in the usual manner with
Betadine. The limb was elevated. Calf tourniquet inflated to
250 mmHg.
Procedure 1: Lapidus fusion, left foot.
An incision was made along the 1st ray segment. Layered
dissection was carried out. In a wedge fashion, the 1st
metatarsal cuneiform joint was resected. K-wire was used to
fenestrate the subchondral bone plate. Using fluoroscopic
guidance, the ostium was closed, stabilized with two cannulated
cancellous screws and then later a 0.062 inch K-wire was used
for additional stabilization. The wound was layer closed with
Vicryl and nylon.
Procedure 2: Bunionectomy with Akin osteotomy, left foot.
An incision was made along the 1st metatarsophalangeal joint and
great toe. Layered dissection was carried out. The medial
eminence of the joint was resected with a sagittal saw, made
smooth with a power bur, and the interspace of the fibular
sesamoid was freed. The great toe still had a lateral deviation
to it. An oblique osteotomy was made through the proximal
phalanx. A 0.062 inch K-wire was just in the medial base of the
proximal phalanx. A thin wedge of bone was taken distal and
medial to that. The K-wire was removed. The hinge was
feathered. Osteotomy was closed, stabilized with a cannulated
cancellous screw, repaired with Vicryl and nylon.
Procedure 3: Osteotomy of shortened left 2nd metatarsal.
A 3 cm oblique incision was made across the 2nd
metatarsophalangeal joint. Layered dissection was carried out.
Long extensor tendon was tied. It was lengthened slightly after
freeing the hood ligament and repaired with Vicryl. A
wedge-shaped cut was made through the capsule. Weil-type
osteotomy was made through the metatarsal. The head fragment
was shifted approximately 3 mm and stabilized with a 2.0 mm
cancellous screw. A dorsal wedge of bone was resected. Repair
was carried out with Vicryl and nylon.
Procedure 4: Arthroplasty, left 2nd toe.
Two semi-elliptical incisions were made dorsally. Ellipsed
tissue was removed. Bone was resected from the proximal
phalangeal joint. Toe was held straight and stabilized with a
0.062-inch K-wire. Skin was repaired with nylon. Wounds were
dressed with Xeroform, fluff gauze, and Kling. Tourniquet time
was approximately 90 minutes. Vascularity was intact to the
foot. Short-leg fiberglass walking cast was applied. The
patient left the operating in good condition.
**Thank you for your input, I also would also be very grateful connecting with someone with more Podiatry experience than I have. I am feeling good with office, office procedures, but it's the surgeries that have me second guessing myself as I am not new to surgery but have never done feet. I would be very appreciative to be able to connect with someone who really knows this area and wouldn't mind sharing their expertise.
Thanks so much!
Tammy
1. Lapidus fusion, left.
2. Bunionectomy with Akin osteotomy, left.
3. Osteotomy of shortened left 2nd metatarsal.
4. Arthroplasty, left 2nd toe.
Description Of Procedure:
The patient was brought to the operating room and placed on the
table in supine position. General anesthetic was provided by
the Anesthesia Department. I administered the ankle block. The
left foot and ankle were prepped in the usual manner with
Betadine. The limb was elevated. Calf tourniquet inflated to
250 mmHg.
Procedure 1: Lapidus fusion, left foot.
An incision was made along the 1st ray segment. Layered
dissection was carried out. In a wedge fashion, the 1st
metatarsal cuneiform joint was resected. K-wire was used to
fenestrate the subchondral bone plate. Using fluoroscopic
guidance, the ostium was closed, stabilized with two cannulated
cancellous screws and then later a 0.062 inch K-wire was used
for additional stabilization. The wound was layer closed with
Vicryl and nylon.
Procedure 2: Bunionectomy with Akin osteotomy, left foot.
An incision was made along the 1st metatarsophalangeal joint and
great toe. Layered dissection was carried out. The medial
eminence of the joint was resected with a sagittal saw, made
smooth with a power bur, and the interspace of the fibular
sesamoid was freed. The great toe still had a lateral deviation
to it. An oblique osteotomy was made through the proximal
phalanx. A 0.062 inch K-wire was just in the medial base of the
proximal phalanx. A thin wedge of bone was taken distal and
medial to that. The K-wire was removed. The hinge was
feathered. Osteotomy was closed, stabilized with a cannulated
cancellous screw, repaired with Vicryl and nylon.
Procedure 3: Osteotomy of shortened left 2nd metatarsal.
A 3 cm oblique incision was made across the 2nd
metatarsophalangeal joint. Layered dissection was carried out.
Long extensor tendon was tied. It was lengthened slightly after
freeing the hood ligament and repaired with Vicryl. A
wedge-shaped cut was made through the capsule. Weil-type
osteotomy was made through the metatarsal. The head fragment
was shifted approximately 3 mm and stabilized with a 2.0 mm
cancellous screw. A dorsal wedge of bone was resected. Repair
was carried out with Vicryl and nylon.
Procedure 4: Arthroplasty, left 2nd toe.
Two semi-elliptical incisions were made dorsally. Ellipsed
tissue was removed. Bone was resected from the proximal
phalangeal joint. Toe was held straight and stabilized with a
0.062-inch K-wire. Skin was repaired with nylon. Wounds were
dressed with Xeroform, fluff gauze, and Kling. Tourniquet time
was approximately 90 minutes. Vascularity was intact to the
foot. Short-leg fiberglass walking cast was applied. The
patient left the operating in good condition.
**Thank you for your input, I also would also be very grateful connecting with someone with more Podiatry experience than I have. I am feeling good with office, office procedures, but it's the surgeries that have me second guessing myself as I am not new to surgery but have never done feet. I would be very appreciative to be able to connect with someone who really knows this area and wouldn't mind sharing their expertise.
Thanks so much!
Tammy