Wiki Metatarsal Head Resection VS. Amputation


Williamsport, PA
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Can someone take a look at this report? The doctor picked an amputation code for this procedure, then states he only excised the metatarsal head. Thanks!

Following satisfactory placement of the patient supine on the operating table satisfactory timeout was accomplished, satisfactory general anesthesia was induced by Dr. taken, and sterile prep and drape of the left lower extremity was accomplished. The left first metatarsal head had osteomyelitis and an underlying plantar ulcer. As such a 3-1/2 cm longitudinal incision was made with a 15 blade overlying the metatarsal head and distal shaft of the metatarsal. The incision was carried down through the subcutaneous tissues down onto the metatarsal shaft and carried through to the metatarsal head. Dissection proceeded to free up the metatarsal and then a micro-oscillating saw was used to transect the metatarsal shaft at the distal third. Once transected the metatarsal shaft was grasped with a towel clip was a brittle bone and it splintered. But with a grasping elevation was accomplished away from the underlying soft tissues in the plantar surface along with tenderness insertions and these were debrided and excised the sesamoid bone was also identified and excised. The metatarsal head was separated from the proximal great toe at the joint space. The proximal area of the first metatarsal shaft was sent for culture and the metatarsal head was sent for culture and pathologic examination. The sesamoid bone was also sent for culture and for pathologic examination. Following this the surgical bed was irrigated with saline and then closed with 3-0 Monocryl for the subcutaneous tissue after satisfactory hemostasis and the skin was closed with interrupted 4-0 Prolene sutures. Sterile dressing Kling and Ace wrap was applied. Patient tolerated procedure well was taken to recovery room in stable condition.