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  1. #1
    Default 28296??
    Exam Training Packages
    INDICATIONS: The patient is an elderly female with diabetes who has had a persistent ulceration of the first metatarsal head. Radiographs revealed large, prominent sesamoid and metatarsal head. She had had a previous toe amputation. Due to failure of conservative therapy, she is brought to the operating room at this time for excision of sesamoid and metatarsal head.

    She was taken to the operating room, and placed in the supine position. After adequate popliteal block and IV sedation was administered, the right foot was prepped and draped in the usual sterile fashion. The callus over the ulcerative area was débrided, and the ulcer was noted to be about 5 mm in diameter. After this was completed, incision was made on the dorsomedial aspect of the first metatarsal, and sharp dissection carried down through the subcutaneous tissue, down to the bone. A subperiosteal dissection was then performed of the distal 2 cm of the metatarsal head. Once it was fully identified, Homan retractor was placed. Using a saw, a metatarsal osteotomy was performed, and the distal 2 cm of the metatarsal in a plantar flexed position was excised. The edges of the bone were rongeured smooth.

    Attention was then turned to the sesamoid complex. Previous medial sesamoid had been excised. The lateral sesamoid was large and prominent. Using a Beaver blade, a subperiosteal dissection of the sesamoid in this complex was performed. At this point, any additional nonviable tissue was débrided. The tourniquet was released, and hemostasis was obtained with electrocautery. The wound was then copiously irrigated. Closure was obtained with 3-0 Vicryl in the subcutaneous tissue, and 4-0 nylon in the skin. Sterile dressing applied.

    Overall, she tolerated it well. She will be taken to the recovery room and discharged to home. Follow up in the office in two weeks. Vicodin for pain. Heel weightbearing only. Call the office or on-call physician if any additional problem arises.

  2. #2
    28111 is used for the excision of the 1st MT head. The sesamoidectomy would not be separately billable since it has a separate procedure status.

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