• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We’re introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Plantar fasciectomy distal tarsal tunnel release Baxters nerve release

MELJNBBRB

Guru
Messages
211
Location
Austin
Best answers
0
28060-RT
28035-RT


Hello podiatry coders, still learning Podiatry and this is the first time for me to see this.

TIa
MB,CCS,CPC




Pre-operative Diagnosis:

1. Plantar fasciitis right foot

2. Baxter's neuritis/nerve entrapment right foot




Post-operative Diagnosis:

Same as above




Procedure:

1. Plantar fasciectomy right foot

2. Distal tarsal tunnel release right foot

3. Baxter's nerve release right foot




Findings: consistent with diagnosis




Estimated Blood Loss: Minimal



Drains: wright medical swanson drain



Total IV Fluids: per anesthesia



Specimens: plantar fascia specimen right foot



Hemostasis:

A well padded tourniquet was placed about the right calf set at 250 mmHg




Injectables:

30 mL of 0.5% marcaine plain and 1% plain lidocaine was infiltrated proximal to the incision site.




Implants: none



Complications: None; patient tolerated the procedure well.



Disposition: PACU - hemodynamically stable.



Condition: stable




Attending Attestation: I performed the procedure.









Anesthesia: General endotracheal anesthesia




Procedure Details

The patient was seen in the Holding Room. The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The risks and potential complications of their problem and purposed treatment include but are not limited to infection, nerve injury, vascular injury, nonunion of the syndesmosis, persistent pain, potential skin necrosis, deep vein thrombosis, possible pulmonary embolus, complications of the anesthetics and failure of the implant. The patient concurred with the proposed plan, giving informed consent. The site of surgery properly noted/marked. The patient was identified as and the procedure verified. A Time Out was held and the above information confirmed.

The patient was brought to the operating room, placed in the supine position on the operative table.




After adequate induction of anesthesia, the tourniquet was placed, the patient?s right lower extremity was prepped and draped in the usual sterile fashion.




The right lower leg was elevated and the exsanguinated with an esmarch bandage.




The right calf tourniquet was inflated and esmarch bandage was then released.




Procedure #1

- Attention was directed to the medial aspect of the right foot and ankle, approximately 1cm posterior and inferior to the medial malleolus, where an approximate 10cm linear longitudinal incision was made along the tract of the tarsal tunnel extending to the plantar surface of the right foot to the midline of the plantar heel just anterior to the WB surface of the plantar heel fat pad.

- This incision was carried deep utilizing a combination of blunt and sharp dissection, carefully retracting a side all major neurovascular structures and tendons, taking care to clamp and bovie all bleeders when necessary.

- The deep fascia overlying the the abductor hallucis brevis was incised.

- The inferior portion of the flexor retinaculum overlying the tarsal tunnel was incised and released to the level of the inferior medial malleolus.

- Identification of the tibial nerve as it branched into the medial and lateral plantar nerves was identified with the venae comitantes at the level of the porta pedia / abductor hiatus.

- The porta pedis / abductor hiatus was released and dilated.

- At this time attention was directed to the plantar fascia in which the medial and central portion were identified.

- A 1.0 cm section of the medial and central bands of the plantar fascia were resected just distal to the origin on the calcaneal tuberosity.

- the section was sent to pathology.

- The quadratus plantae and flexor digitorum brevis fascia were released deeply along the inferior surface of the calcaneus.

- There was no remaining tight fascial structures surrounding the tibial nerve, medial and lateral plantar nerves and the Baxter's nerve as it coursed laterally across the plantar heel.



The wound was flushed with copious amounts of normal physiologic sterile saline and inspected for any soft tissue or osseous debris, none of which was found.

The correction was found to be adequate.




The skin edges were reapproximated with 4-0 prolene suture using horizontal mattress sutures.




Postoperative bandage was applied to the right foot foot incision site consisting of Adaptec 4 X 4 gauze, Kling gauze, Kerlix gauze, and Coban self-adhering tape, postoperative posterior splint.




The pneumatic calf tourniquet was released with immediate reactive hyperemia noted to the digits of the patient?s right foot.




The patient tolerated the anesthesia and procedure well and left the operating room with vital signs stable and vascular status intact.

The patient was transported to the recovery room for continued monitoring until the criteria for discharge summary had been met.

The patient was given postoperative instructions and advised to follow up with Dr. in his office for all-postoperative care and management
 
Top