27650??
thanks
JNB,CCS,CPC
Preoperative Diagnosis:
1. Retrocalcaneal exostosis, left foot
2. Achilles tendinosis, left foot
Post-operative Diagnosis:
Same
Procedure:
1. Retrocalcaneal exostectomy with detachment, debridement, and reattachment of the Achilles tendon using Arthrex Achilles Speedbridge, Left foot
Anesthesia:
General Anesthesia
Pre-op: Popliteal block
Hemostasis:
Pneumatic Thigh Touniquet at 300 mmHg for 64 minutes
Fluids:
1000 cc Lactated Ringers
Estimated Blood Loss:
None
Materials/Suture:
2-0 Vicryl, 3-0 Vicryl and 3-0 Nylon
Arthrex Achilles Speedbridge
Complications: None apparent.
Procedure in Detail:
Patient was visited in the pre-operative holding unit and correct site, correct patient identified. Interval H&P was performed. Discussed plan with patient and reiterated risk versus benefits. All questions answered.
Patient taken to the operating room via cart and transferred to the operating table in a prone position. A safety strap was placed across the patient's waist for protection. All bony prominences were padded and an electrocautery ground pad was placed on the thigh. Anesthesia applied the appropriate monitors to the patient. A time out was performed, consent was read, allergies, correct site and correct procedure, and sterility/presence of necessary equipment/implants confirmed. General Anesthesia was induced.
A well padded tourniquet was applied along with protective steri drape. The operative foot was prepped and draped in the usual aseptic fashion. The foot was exsanguinated with an esmarch bandage and the pneumatic tourniquet was elevated to the pressure listed above.. The foot was lowered into the operative field and the sterile stockinet was reflected
Attention was directed to the posterior aspect of the heel, where an approx. 7 cm linear incision was placed over the central portion of the achilles tendon to calcaneus below the insertion. Incision was deepened through subcutaneous tissues, retracting all neurovascular structure and ligating all bleeders. Taking care to maintain full thickness of the flap, the skin and underlying subcutaneous tissues and fat padding were reflected from the paratenon layer encasing the tendon. The paratenon was incised. An inverted T incision was made in the Achilles tendon and the tendon was reflected and completely detached from it's insertion to the posterior calcaneus. At the insertion site, the tendon was notably thickened with fibrinous chronic tendinosis changes, and a large posterior calcaneal exostosis (consistent with preoperative radiographs) as well as enlarged bursal projection were present. The undersurface of the tendon was de-bulked of the chronic fibrinous tissue. Attention was then directed to the prominent posterior calcaneal exostosis and bursal projection which was consistent with preoperative radiographs. Using a power saw, the exostosis, as well as a small portion of the posterior-superior calcaneus was resected and passed from the field. After the calcaneal exostectomy procedure was preformed, the tendon was primarily repaired and reattached using the above mentioned anchoring system according to the manufacturer's instructions. The achilles tendon incision was then reapproximated with 2-0 Vicryl using continous running horizontal mattress technique. The skin was reapproximated with horizontal mattress using 3-0 Nylon.
The pneumatic tourniquet was released and immediate hyperemia was noted to the digits. The anesthesia was reversed and the patient was transported in stable condition to the PACU with vital signs stable and vascular status intact to the foot. Patient was given explicit written instructions, emergency contact numbers, post-operative analgesics, anti-emetics, and explicit offloading instructions. CAM walker and crutches were dispensed by the PACU nurses and appropriate education regarding used of these devices were provided. Patient has scheduled follow-op appointment.
HELP retrocalcaneal exostectomy with detachment, debridement and reattachment ?
