LScoder2016
Networker
A incision encompassing the left hallux extending dorsally along the 1st metatarsal was mapped
out. A 15 blade was used to make an incision encompassing the hallux extending along the
dorsal medial 1st metatarsal. The hallux was disarticulated at the 1st metatarsophalangeal joint
and sent to pathology. The bone of the hallux was noted to be visually soft and irregular
consistent with osteomyelitis.
Incision was extended along the 1st metatarsal and a 15 blade and
key elevator was used to dissect the soft tissue encompassing the 1st metatarsal. The 1st
metatarsal was noted to be discolored in appearance with destructive changes as well as soft in
texture. The 1st tarsometatarsal joint was identified and the 1st metatarsal was disarticulated at
the level. A 15 blade was then used to free 1st metatarsal from its soft tissue attachments. First
metatarsal was handed to the back table sent to pathology.
Next incision was extended proximally and dissection was carried down to level of the medial
cuneiform which visually appeared discolored, irregular and soft consistent with osteomyelitis.
This was excised in its entirety using 15 blade. The medial cuneiform was sent to pathology.
Next attention was directed to the sesamoid apparatus. Using a Kocher and 15 blade this was
excised from its soft tissue attachments and sent to pathology. A rongeur was then used to
remove remaining nonviable soft tissue within the amputation site.
The surgical site was then copiously irrigated using normal saline solution outer gloves were
exchanged clean instrumentation was used going forward.
Attention was directed to the navicular which was visible within the surgical wound. A rongeur
was used to obtain a sample of bone for culture and sensitivities as well as pathology. Next the
wound was packed with vancomycin impregnated calcium sulfate antibiotic beads. Hemostasis
was achieved using combination of electrocautery and topical thrombin.
Next attention was turned to the dorsal lateral midfoot where a 5 cm incision was marked out
overlying the cuboid. A fresh 15 blade was then used to make a incision dorsally immediately
abscess was encountered. A culture of the purulent drainage was obtained. There was about 10
cc of purulent drainage expressed from the dorsal foot. Blunt dissection was carried down along
the dorsal lateral foot below the deep fascia and its soft tissue structures to express any remaining
abscess. Multiple bursal spaces were bluntly dissected and explored for any further abscess or
signs of infection. No proximal sinus tracking or sinus tracking to the medial foot was noted. All
nonviable and infected appearing soft tissue was sharply excised utilizing a 15 blade and rongeur.
The wound was then copiously irrigated using normal saline solution. Outer gloves were
exchanged and clean instrumentation was used going forward. A specimen of cuboid bone was
obtained for pathology and micro using a Jamshidi needle.
out. A 15 blade was used to make an incision encompassing the hallux extending along the
dorsal medial 1st metatarsal. The hallux was disarticulated at the 1st metatarsophalangeal joint
and sent to pathology. The bone of the hallux was noted to be visually soft and irregular
consistent with osteomyelitis.
Incision was extended along the 1st metatarsal and a 15 blade and
key elevator was used to dissect the soft tissue encompassing the 1st metatarsal. The 1st
metatarsal was noted to be discolored in appearance with destructive changes as well as soft in
texture. The 1st tarsometatarsal joint was identified and the 1st metatarsal was disarticulated at
the level. A 15 blade was then used to free 1st metatarsal from its soft tissue attachments. First
metatarsal was handed to the back table sent to pathology.
Next incision was extended proximally and dissection was carried down to level of the medial
cuneiform which visually appeared discolored, irregular and soft consistent with osteomyelitis.
This was excised in its entirety using 15 blade. The medial cuneiform was sent to pathology.
Next attention was directed to the sesamoid apparatus. Using a Kocher and 15 blade this was
excised from its soft tissue attachments and sent to pathology. A rongeur was then used to
remove remaining nonviable soft tissue within the amputation site.
The surgical site was then copiously irrigated using normal saline solution outer gloves were
exchanged clean instrumentation was used going forward.
Attention was directed to the navicular which was visible within the surgical wound. A rongeur
was used to obtain a sample of bone for culture and sensitivities as well as pathology. Next the
wound was packed with vancomycin impregnated calcium sulfate antibiotic beads. Hemostasis
was achieved using combination of electrocautery and topical thrombin.
Next attention was turned to the dorsal lateral midfoot where a 5 cm incision was marked out
overlying the cuboid. A fresh 15 blade was then used to make a incision dorsally immediately
abscess was encountered. A culture of the purulent drainage was obtained. There was about 10
cc of purulent drainage expressed from the dorsal foot. Blunt dissection was carried down along
the dorsal lateral foot below the deep fascia and its soft tissue structures to express any remaining
abscess. Multiple bursal spaces were bluntly dissected and explored for any further abscess or
signs of infection. No proximal sinus tracking or sinus tracking to the medial foot was noted. All
nonviable and infected appearing soft tissue was sharply excised utilizing a 15 blade and rongeur.
The wound was then copiously irrigated using normal saline solution. Outer gloves were
exchanged and clean instrumentation was used going forward. A specimen of cuboid bone was
obtained for pathology and micro using a Jamshidi needle.