mfonder
New
New to Podiatry surgery. I am considering using 28120-59-LT 755.69 and 28119-51-LT for the following surgery. Any help is greatly appreciated! Thanks.
PREOPERATIVE DIAGNOSES:
1. Painful chronic plantar fasciitis, heel spur syndrome, left.
2. Painful accessory bone, posterior aspect of the left
subtalar joint, posterior os trigonum syndrome.
POSTOPERATIVE DIAGNOSES:
1. Painful chronic plantar fasciitis, heel spur syndrome, left.
2. Painful accessory bone, posterior aspect of the left
subtalar joint, posterior os trigonum syndrome.
PROCEDURES PERFORMED:
1. Excision of os trigonum, posterior aspect of the left
subtalar joint.
2. Plantar fascial release, heel spur excision, open, left
CLINICAL RESUME: The patient presents with chronic plantar
fascial pain, left foot, also chronic posterior left ankle pain,
secondary to os trigonum. The patient does wish to undergo
surgical repair procedure. She has not responded to conservative
measures. Surgery risks and complications explained to patient.
No guarantees could be given.
DESCRIPTION OF OPERATION: The patient was brought to the
operating room and placed on the operating table in supine
position. She was administered general inhalation anesthesia and
local anesthetic. The left foot and ankle were prepped and draped
in the standard sterile fashion. Tourniquet was applied to the
thigh and the leg was elevated for 3 minutes and inflated to 325
mmHg. Attention was then directed to the lateral left ankle. An
approximately 4-cm was made just over the peroneal tendons
following the fibula. The C-arm was utilized to localize the
accessory bone or os trigonum. Dissection was then carried very
carefully back to the posterior ankle, subtalar joint complex.
Sural nerve and saphenous vein were retracted out of the field. A
posterior incision was made through the ankle capsule and
subtalar joint. The accessory bone was identified. Great care was
taken to make sure we avoided the neurovascular structures
medially. Flexor hallucis longus tendon was identified by flexing
a toe. Rongeur was utilized to remove the spurring along the
posterior aspect of the calcaneus and talus. A bone rasper was
utilized to smooth down the bone in the joint. Verification of
removal of the spur was done under the C-arm. Good range of
motion of the subtalar joint and the ankle joint was noted. The
wound was flushed copiously with normal sterile saline. Deep
fascia layer was closed with 2-0 Vicryl in a simple interrupted
fashion, superficial fascial layer was closed with 4-0 Vicryl in
a simple interrupted fashion. Skin was closed with 4-0 nylon in a
simple interrupted fashion.
Attention was directed to the plantar medial aspect of the left
heel. A 5-cm curvilinear incision was made along the plantar
medial edge of the foot and angled toward the plantar fascia.
Dissection was carried deeply distally until the plantar fascia
was identified. Then the dissection was carried bluntly back to
the insertional area to the heel. The plantar fascia was noted
to be quite thickened and degenerative in appearance. It was
resected from the plantar medial heel under direct visualization.
A spur was then identified and removed with a rongeur and rasped
smooth. Wound was flushed copiously with normal sterile saline.
No other abnormalities noted in the area. The wound was closed in
1 layer with 3-0 nylon in vertical mattress fashion and 4-0 nylon
in a simple interrupted fashion.
PREOPERATIVE DIAGNOSES:
1. Painful chronic plantar fasciitis, heel spur syndrome, left.
2. Painful accessory bone, posterior aspect of the left
subtalar joint, posterior os trigonum syndrome.
POSTOPERATIVE DIAGNOSES:
1. Painful chronic plantar fasciitis, heel spur syndrome, left.
2. Painful accessory bone, posterior aspect of the left
subtalar joint, posterior os trigonum syndrome.
PROCEDURES PERFORMED:
1. Excision of os trigonum, posterior aspect of the left
subtalar joint.
2. Plantar fascial release, heel spur excision, open, left
CLINICAL RESUME: The patient presents with chronic plantar
fascial pain, left foot, also chronic posterior left ankle pain,
secondary to os trigonum. The patient does wish to undergo
surgical repair procedure. She has not responded to conservative
measures. Surgery risks and complications explained to patient.
No guarantees could be given.
DESCRIPTION OF OPERATION: The patient was brought to the
operating room and placed on the operating table in supine
position. She was administered general inhalation anesthesia and
local anesthetic. The left foot and ankle were prepped and draped
in the standard sterile fashion. Tourniquet was applied to the
thigh and the leg was elevated for 3 minutes and inflated to 325
mmHg. Attention was then directed to the lateral left ankle. An
approximately 4-cm was made just over the peroneal tendons
following the fibula. The C-arm was utilized to localize the
accessory bone or os trigonum. Dissection was then carried very
carefully back to the posterior ankle, subtalar joint complex.
Sural nerve and saphenous vein were retracted out of the field. A
posterior incision was made through the ankle capsule and
subtalar joint. The accessory bone was identified. Great care was
taken to make sure we avoided the neurovascular structures
medially. Flexor hallucis longus tendon was identified by flexing
a toe. Rongeur was utilized to remove the spurring along the
posterior aspect of the calcaneus and talus. A bone rasper was
utilized to smooth down the bone in the joint. Verification of
removal of the spur was done under the C-arm. Good range of
motion of the subtalar joint and the ankle joint was noted. The
wound was flushed copiously with normal sterile saline. Deep
fascia layer was closed with 2-0 Vicryl in a simple interrupted
fashion, superficial fascial layer was closed with 4-0 Vicryl in
a simple interrupted fashion. Skin was closed with 4-0 nylon in a
simple interrupted fashion.
Attention was directed to the plantar medial aspect of the left
heel. A 5-cm curvilinear incision was made along the plantar
medial edge of the foot and angled toward the plantar fascia.
Dissection was carried deeply distally until the plantar fascia
was identified. Then the dissection was carried bluntly back to
the insertional area to the heel. The plantar fascia was noted
to be quite thickened and degenerative in appearance. It was
resected from the plantar medial heel under direct visualization.
A spur was then identified and removed with a rongeur and rasped
smooth. Wound was flushed copiously with normal sterile saline.
No other abnormalities noted in the area. The wound was closed in
1 layer with 3-0 nylon in vertical mattress fashion and 4-0 nylon
in a simple interrupted fashion.