20680
28104??? tia
PREOPERATIVE DIAGNOSES:
1. Exostosis, left mid foot.
2. Painful retained hardware.
POSTOPERATIVE DIAGNOSES:
1. Exostosis, left mid foot.
2. Painful retained hardware.
PROCEDURE:
1. Left central mid foot exostosis.
2. Left medial mid foot exostosis with removal of retained
hardware.
PATHOLOGY:
None.
ESTIMATED BLOOD LOSS:
Minimal.
MATERIALS:
1. 2-0 Vicryl.
2. 3-0 nylon.
INJECTABLES:
10 mL 2% lidocaine plain preoperatively, 10 mL 0.5% Marcaine
plain postoperatively.
COMPLICATIONS:
None apparent.
SUMMARY OF PROCEDURE:
The patient brought in the operating room, placed on the table
in a supine position. Time-out was performed with myself in
the room. Anesthesia induced. 2% lidocaine plain injected.
Foot prepped and draped using standard aseptic technique.
Esmarch bandage utilized for exsanguination of limb and
tourniquet elevated to 250 mmHg.
Dorsal incision first made over the left central mid foot
lateral to the dorsalis pedis artery. It was deepened down
with blunt dissection. There was a large prominent bony
exostosis extending approximately 2.5 x 3 cm at the level of the metatarsal bases and dorsal central cuneiform. A combination of hand
instruments as well as sagittal saw and rasp was utilized to
reduce exostosis, confirmation of reduction of exostosis
confirmed on fluoroscan. Irrigation employed. Of note, no
hardware visible or palpable in this area. Deep tissues
closed with Vicryl. Skin closed with nylon.
Attention then directed to the medial aspect of the mid foot
over the first metatarsal cuneiform joint where there is a
palpable exostosis as well as prominent hardware incision was
made over the prominent hardware and exostosis measuring 2 cm
length. It was deepened down with care to cauterize
superficial structures. Prominent screw head was identified,
broken screw removal kit was utilized to remove the screw in
total. Confirmation on fluoroscan performed, hand instruments
as well as power instrumentation utilized to reduce exostosis,
irrigation employed. Deep structures closed with Vicryl.
Skin closed with nylon. Well-padded bandage was applied.
Tourniquet released and immediate capillary refill to toes.
He was awakened and transferred to recovery with all vital
signs stable.
28104??? tia
PREOPERATIVE DIAGNOSES:
1. Exostosis, left mid foot.
2. Painful retained hardware.
POSTOPERATIVE DIAGNOSES:
1. Exostosis, left mid foot.
2. Painful retained hardware.
PROCEDURE:
1. Left central mid foot exostosis.
2. Left medial mid foot exostosis with removal of retained
hardware.
PATHOLOGY:
None.
ESTIMATED BLOOD LOSS:
Minimal.
MATERIALS:
1. 2-0 Vicryl.
2. 3-0 nylon.
INJECTABLES:
10 mL 2% lidocaine plain preoperatively, 10 mL 0.5% Marcaine
plain postoperatively.
COMPLICATIONS:
None apparent.
SUMMARY OF PROCEDURE:
The patient brought in the operating room, placed on the table
in a supine position. Time-out was performed with myself in
the room. Anesthesia induced. 2% lidocaine plain injected.
Foot prepped and draped using standard aseptic technique.
Esmarch bandage utilized for exsanguination of limb and
tourniquet elevated to 250 mmHg.
Dorsal incision first made over the left central mid foot
lateral to the dorsalis pedis artery. It was deepened down
with blunt dissection. There was a large prominent bony
exostosis extending approximately 2.5 x 3 cm at the level of the metatarsal bases and dorsal central cuneiform. A combination of hand
instruments as well as sagittal saw and rasp was utilized to
reduce exostosis, confirmation of reduction of exostosis
confirmed on fluoroscan. Irrigation employed. Of note, no
hardware visible or palpable in this area. Deep tissues
closed with Vicryl. Skin closed with nylon.
Attention then directed to the medial aspect of the mid foot
over the first metatarsal cuneiform joint where there is a
palpable exostosis as well as prominent hardware incision was
made over the prominent hardware and exostosis measuring 2 cm
length. It was deepened down with care to cauterize
superficial structures. Prominent screw head was identified,
broken screw removal kit was utilized to remove the screw in
total. Confirmation on fluoroscan performed, hand instruments
as well as power instrumentation utilized to reduce exostosis,
irrigation employed. Deep structures closed with Vicryl.
Skin closed with nylon. Well-padded bandage was applied.
Tourniquet released and immediate capillary refill to toes.
He was awakened and transferred to recovery with all vital
signs stable.