Patient was brought into the operating room and placed on the operating table in the supine position with
IV intact for IV sedation. He was anesthetized utilizing a 50-50 mixture of 0.25% Marcaine plain and
1% Xylocaine plain in the form of an ankle block, 10 mL total volume was utilized. The right foot and
ankle was prepped and draped in the usual aseptic manner. The Esmarch bandage was maintained at the
level of the ankle in order to achieve hemostasis throughout the procedure as an ankle tourniquet.
Attention was then directed to the lateral aspect of the ankle and foot where a circumferential incision
was performed, excising the ulceration. This ulceration was 8 cm x 4 cm x 2 cm deep. It penetrated into
the subcutaneous tissues and fascial tissues, which were sharply debrided, along with nonviable muscle,
fascia, tendon, subcutaneous fat and skin. All those were resected to healthy bleeding granulation tissue,
flushed copiously with the Pulsavac, 1 liter of fluid with 80 mg of gentamicin. A small incision was
performed over the 4th metatarsal base and dissection was carried through the skin down to the level of
the 4th metatarsal base where a small segment of bone was resected. We resected a 1cm x 1 cm x 0.5 cm cube of bone. The bone seemed pretty healthy, for the most part. It did not have
purulence. We resected it for a bone culture to determine whether the 4th metatarsal base was infected.
We resected that bone, flushed the area copiously, and then I used saline soaked gauze and packed both
wounds open. We applied Betadine soaked adaptic, Betadine soaked gauze, dry sterile compressions
with multiple layers of padding and ABD pads to absorb any drainage. Tourniquet was let down.
Capillary refill returned to the foot and ankle. Patient tolerated the procedure and anesthesia well and
left the operating room with vital signs stable and neurovascular status grossly intact.