lauraburden
Contributor
I am stumped on this surgery. Can someone please help? I have so far the 27612 but from there I am sort of lost. Thank you in advance.
Scrubbed note below:
A zig-zag incision was made on the posterior ankle overlying the achilles tendon. Full thickness flaps were developed and the tenoachilles was exposed. A Z-lengthening was performed with release of the medial limb distally.
The deep posterior compartment of the leg was opened with exposure of the flexor hallucis longus and its tendon. The muscle belly was swept medially along with the neurovascular bundle. The tendon sheath of the FDL was opened to the level of the medial malleolus with care to avoid injury to the flexor digitorum longus.
The lateral compartment was opened with identification of the peroneal muscle bellies and tendons. Their tendon sheaths were opened to the level of the lateral malleolus and retracted laterally.
A capsulectomy was perfomed of the posterior tibiotalar and subtalar joints.
There was found to be improved passive ankle dorsiflexion to 15-20degrees.
A 2mm smooth K wire was passed retrograde through the heel and across the subtalar and ankle joints, securing the foot in slight dorsiflexion. The end was trimmed and bent. The achilles was then reapproximated in slight tension.
The wound was then closed in two layers with absorbable suture and bonded. The tourniquet was released.
For the left leg an identical procedure was performed. However there was a significant co contracture of the posterior tibialis and the toe flexors. THis was treated with an open fractional lengthening of their muscle bellies made through a seperate 1 inch incision at the mid-distal posteromedial shin. A residual long flexor deformity of the great toe was treated with a percutaneous tenotomy of the long flexor tendon through a stab incision at the PIP joint.
Scrubbed note below:
A zig-zag incision was made on the posterior ankle overlying the achilles tendon. Full thickness flaps were developed and the tenoachilles was exposed. A Z-lengthening was performed with release of the medial limb distally.
The deep posterior compartment of the leg was opened with exposure of the flexor hallucis longus and its tendon. The muscle belly was swept medially along with the neurovascular bundle. The tendon sheath of the FDL was opened to the level of the medial malleolus with care to avoid injury to the flexor digitorum longus.
The lateral compartment was opened with identification of the peroneal muscle bellies and tendons. Their tendon sheaths were opened to the level of the lateral malleolus and retracted laterally.
A capsulectomy was perfomed of the posterior tibiotalar and subtalar joints.
There was found to be improved passive ankle dorsiflexion to 15-20degrees.
A 2mm smooth K wire was passed retrograde through the heel and across the subtalar and ankle joints, securing the foot in slight dorsiflexion. The end was trimmed and bent. The achilles was then reapproximated in slight tension.
The wound was then closed in two layers with absorbable suture and bonded. The tourniquet was released.
For the left leg an identical procedure was performed. However there was a significant co contracture of the posterior tibialis and the toe flexors. THis was treated with an open fractional lengthening of their muscle bellies made through a seperate 1 inch incision at the mid-distal posteromedial shin. A residual long flexor deformity of the great toe was treated with a percutaneous tenotomy of the long flexor tendon through a stab incision at the PIP joint.