I&D with Fibular Tibial Sesmoidectomies
PROCEDURE IN DETAIL: Under mild sedation, the patient was brought to the operating room and placed on table in supine position. Pneumatic tourniquet was placed about the patient's right ankle. Following general anesthesia, local anesthesia was obtained throughout the patient's right foot utilizing 0.5% Marcaine plain. The foot was scrubbed, prepped and draped in usual aseptic manner. An Esmarch bandage utilized to exsanguinate the patient's foot and the pneumatic tourniquet was then inflated.
Attention was then directed to plantar aspect of the right foot where the area of previous drainage was noted. This area was dissected and elongated with resection of ulcerative tissue. This incision was carried down to the fibular sesamoid where there was noted inflammatory tissue within the plantar aspect of the right foot. The fibular sesamoid was identified. It was significantly hypertrophied and degenerated. This was resected from its surrounding soft tissue structures and passed off the operative field and sent to pathology for both gross and microscopic examination as well as cultures taken.
At this time, the decision was made to resect the tibial sesamoid secondary to the fact that this will be cause of increased pressure in the future especially with respect to the fibular sesamoid and the patient's long history of current resections and ulcerations. This was done without incident. Upon completion of the procedure, the area was flushed with pulse lavage with 1 L with bacitracin followed by appropriate closure. There was an area that was unable to close. This was packed with half-inch Iodoform gauze to be removed by myself in my office. Appropriate dressings were applied, followed by release of the pneumatic tourniquet and hyperemic response to the remaining stump of the right foot.