afryberger
Networker
I have never done orthopaedic surgery before. I have codes 28296,28298,28294. That just doesnt seem right to me. I dont even know if i got everything either.
PREOPERATIVE DIAGNOSIS: Left foot painful bunion deformity.
POSTOPERATIVE DIAGNOSIS: Left foot painful bunion deformity.
PROCEDURE: The patient was brought to the Operating Room and was placed on the Operating Room table in the supine position. A pneumatic ankle tourniquet was then placed on the patient's left ankle. Following IV sedation, local anesthesia was obtained utilizing 20cc of 1:1 mixture of 1% Lidocaine plain, 0.5% marcaine plain. The foot was then prepped, scrubbed and draped in the usual aseptic manner. An Esmarch bandage was then utilized to exsanguinate the patient's right foot and the tourniquet was inflated.
Attention was then directed to the dorsal aspect. The first metatarsal head of the left foot where a 5cm linear longitudinal incision was made, medial and parallel to the tendon of the extensor hallucis longus. The incision was deepened through the subcutaneous tissues, using blunt and sharp dissection. Care was taken to identify and retract all vital neurovascular structures. All bleeders were ligated and cauterized as necessary.
At this time, an inverted L-type capsulotomy was performed over the dorsal aspect of the posterior metatarsal phalangeal joint. The periosteal and capsular structures were then carefully dissected free and reflected medially and laterally, thus exposing the head of the first metatarsal. Utilizing a sagittal saw, the dorsal and medial prominences were resected and passed from the operative field. Attention was then directed to the first inter space with the original skin incision. Blunt and sharp dissection was utilized to reach and visualize the conjoined adductor tendon which was then transected as well as the fibular sesamoid ligament.
The hip was then externally rotated and the knee flexed so that the medial surface of the foot feels superior for better visualization for the Mau procedure. At this time a through and through, oblique osteotomy was performed at the first metatarsal shaft, going from dorsal distal to plantar proximal. The capsular fragment was then shifted laterally into an improved position, and was then impacted on the head of the metatarsal shaft. One, 3.0 18mm screw was then driven across the osteotomy site to provide fixation, followed by an E-Z clip, 10 by 10 by 12 staple, which was placed across the osteotomy site providing excellent fixation.
Using standard AO fixation technique, excellent compression was noted at the osteotomy site at this time. The remaining medial bone shelf as well as all the rough edges of the bone were then resected and smoothed using power equipment. At this time to further correct the bunion deformity, extensive digitorum brevis tendon was identified, isolated and transected at the insertion site. Following this, the bunion deformity was noted to be vascularly improved.
At this time, the incision was lengthened to the DIPJ of the left hallux. Followed by the incision was deepened through the subcutaneous tissues using blunt and sharp dissection. Care was taken to identify and attract all vital neurovascular structures. All bleeders were ligated and cauterized as necessary. Dissection was carried out bluntly and sharply so that the dorsal and medial aspects of the proximal phalanx of the left hallux were exposed and visualized.
Utilizing a sagittal saw, a distal Akin osteotomy involving a dorsal to plantar, through and through osteotomy was performed to the distal diaphyseal shaft of the proximal phalanx, followed by another dorsal to plantar, through and through osteotomy which was made approximately 2mm proximal to the first site, so that a rectangular wedge was noted. The wedge was removed and passed from the operative field. An E-Z clip, 10 by 10 by 10 staple was driven across the osteotomy site to provide fixation. The wound was then flushed with copious amounts of sterile saline, and the periosteal and capsular structures were re-approximated using 3-0 Vicryl.
Redundant capsular tissue was resected as needed and subcutaneous tissues were then closed with 3-0 Vicryl as well. Skin edges were then coapted using 4-0 nylon in a horizontal mattress suture stage. Upon completion of the procedure, the incision site was dressed with Betadine soaked adaptic and covered with sterile compressive dressing such as 4 by 4s and Kling. The tourniquet was then deflated and immediate hyperemia was noted to have returned to all digits. The foot was then Ace wrapped. At this time, a left lower extremity, posterior splint was applied to the left lower extremity of the patient. The patient tolerated the procedure well and was transferred to the Recovery Room with all vital signs stable and vascular status intact to both feet.
Following postoperative monitoring, the patient will be discharged and given instructions and prescriptions which were discussed prior to the surgery.
PREOPERATIVE DIAGNOSIS: Left foot painful bunion deformity.
POSTOPERATIVE DIAGNOSIS: Left foot painful bunion deformity.
PROCEDURE: The patient was brought to the Operating Room and was placed on the Operating Room table in the supine position. A pneumatic ankle tourniquet was then placed on the patient's left ankle. Following IV sedation, local anesthesia was obtained utilizing 20cc of 1:1 mixture of 1% Lidocaine plain, 0.5% marcaine plain. The foot was then prepped, scrubbed and draped in the usual aseptic manner. An Esmarch bandage was then utilized to exsanguinate the patient's right foot and the tourniquet was inflated.
Attention was then directed to the dorsal aspect. The first metatarsal head of the left foot where a 5cm linear longitudinal incision was made, medial and parallel to the tendon of the extensor hallucis longus. The incision was deepened through the subcutaneous tissues, using blunt and sharp dissection. Care was taken to identify and retract all vital neurovascular structures. All bleeders were ligated and cauterized as necessary.
At this time, an inverted L-type capsulotomy was performed over the dorsal aspect of the posterior metatarsal phalangeal joint. The periosteal and capsular structures were then carefully dissected free and reflected medially and laterally, thus exposing the head of the first metatarsal. Utilizing a sagittal saw, the dorsal and medial prominences were resected and passed from the operative field. Attention was then directed to the first inter space with the original skin incision. Blunt and sharp dissection was utilized to reach and visualize the conjoined adductor tendon which was then transected as well as the fibular sesamoid ligament.
The hip was then externally rotated and the knee flexed so that the medial surface of the foot feels superior for better visualization for the Mau procedure. At this time a through and through, oblique osteotomy was performed at the first metatarsal shaft, going from dorsal distal to plantar proximal. The capsular fragment was then shifted laterally into an improved position, and was then impacted on the head of the metatarsal shaft. One, 3.0 18mm screw was then driven across the osteotomy site to provide fixation, followed by an E-Z clip, 10 by 10 by 12 staple, which was placed across the osteotomy site providing excellent fixation.
Using standard AO fixation technique, excellent compression was noted at the osteotomy site at this time. The remaining medial bone shelf as well as all the rough edges of the bone were then resected and smoothed using power equipment. At this time to further correct the bunion deformity, extensive digitorum brevis tendon was identified, isolated and transected at the insertion site. Following this, the bunion deformity was noted to be vascularly improved.
At this time, the incision was lengthened to the DIPJ of the left hallux. Followed by the incision was deepened through the subcutaneous tissues using blunt and sharp dissection. Care was taken to identify and attract all vital neurovascular structures. All bleeders were ligated and cauterized as necessary. Dissection was carried out bluntly and sharply so that the dorsal and medial aspects of the proximal phalanx of the left hallux were exposed and visualized.
Utilizing a sagittal saw, a distal Akin osteotomy involving a dorsal to plantar, through and through osteotomy was performed to the distal diaphyseal shaft of the proximal phalanx, followed by another dorsal to plantar, through and through osteotomy which was made approximately 2mm proximal to the first site, so that a rectangular wedge was noted. The wedge was removed and passed from the operative field. An E-Z clip, 10 by 10 by 10 staple was driven across the osteotomy site to provide fixation. The wound was then flushed with copious amounts of sterile saline, and the periosteal and capsular structures were re-approximated using 3-0 Vicryl.
Redundant capsular tissue was resected as needed and subcutaneous tissues were then closed with 3-0 Vicryl as well. Skin edges were then coapted using 4-0 nylon in a horizontal mattress suture stage. Upon completion of the procedure, the incision site was dressed with Betadine soaked adaptic and covered with sterile compressive dressing such as 4 by 4s and Kling. The tourniquet was then deflated and immediate hyperemia was noted to have returned to all digits. The foot was then Ace wrapped. At this time, a left lower extremity, posterior splint was applied to the left lower extremity of the patient. The patient tolerated the procedure well and was transferred to the Recovery Room with all vital signs stable and vascular status intact to both feet.
Following postoperative monitoring, the patient will be discharged and given instructions and prescriptions which were discussed prior to the surgery.