8/11/2019 Op Note First Ray

1/2

PREOPERATIVE DIAGNOSIS: ***plantar first metatarsal head ulcer with deep ascess

f!rmati!n and deep tissue necr!sis"

POSTOPERATIVE DIAGNOSIS: ***plantar first metatarsal ulcer with deep ascess f!rmati!nand e#tensi$e necr!sis !f the deep tissues !f the hallu# and plantar first metatarsal% first

interspace"

PRO&ED'RE: *** w!und incisi!n and draina(e with !pen partial first ra) amputati!n"

ANESTESIA: +!cal with m!nit!red anesthetic care"

E,OSTASIS: ***Pneumatic an-le t!urni.uet"

ESTI,ATED /+OOD +OSS: ***m+"

,ATERIA+S: N!ne"

PATO+OG0: Amputated t!e and first metatarsal head sent as (r!ss

specimen",I&RO/IO+OG0: ***Aer!ic and anaer!ic cultures !tained"

IN1E&TA/+ES: N!ne"

DRESSING2S3: Standard"

&O,P+I&ATIONS: N!ne"

PRO&ED'RE IN DETAI+: The patient was r!u(ht int! the !peratin( r!!m and placed supine

!n the tale" Patient recei$ed *** pre!perati$el)" ***Patient did n!t recei$e an) peri!perati$e

antii!tics% as he was alread) !n an IV Vanc!m)cin and 4!s)n re(imen" A sur(ical time5!ut wasta-en in which the patient% the sur(ical site and the pr!cedure were $erified" The pneumatic an-le

t!urni.uet was placed !$er padded 6eril ar!und the ri(ht an-le" The ***f!!t and an-le were

scrued% prepped and draped in the usual aseptic manner" An esmarch anda(e was used t!

e#san(uinate the e#tremit)% and the t!urni.uet was then inflated"

Attenti!n was directed t! the *** hallu#" A s-in incisi!n circumferentiall) ar!und the hallu# and

n!ted the presence !f pus d!rs!lateral)%in the first interspace as well as within the 7!int" Aer!ic

and anaer!ic cultures were !tained%*** and patient recei$ed ***" The hallu# was disarticulated

and sent t! Path!l!() as (r!ss specimen" 'p!n further e#aminati!n we n!ted de$itali8ed tissue

surr!undin( the sesam!ids and !ther s!ft tissues under the plantar surface !f the first metatarsal%

all !f which were e#cised" 'p!n further e#aminati!n we n!ted s!me de$itali8ed tissue al!n( thed!rsal aspect !f the first metatarsal%first interspace surr!undin( the e#tens!r hallucis l!n(us

which was als! e#cised t! appr!#imatel) midshaft !f the first metatarsal" The first metatarsal

head % partial first ra) resecti!n was d!ne usin( a sa(ittal saw in a d!rsal medial distal t! plantar

lateral pr!#imal !rientati!n" The e#cised first metatarsal head was sent t! Path!l!() as (r!ssspecimen" The resecti!n !ne mar(in was felt t! e firm with!ut an) e$idence !f infecti!n" 'sin(

a r!n(eur all !ther de$itali8ed tissue was rem!$ed" 6e did n!t find an) further pr!#imal trac-in(

al!n( the e#tens!r !r fle#!r tend!ns !r within the inner space" All necr!tic % tisue was rem!$ed

The w!und was e#amined and was f!und t! e clear !f an) further de$itali8ed tissue" The w!und

8/11/2019 Op Note First Ray

2/2

was irri(ated with 9 + !f n!rmal saline usin( a pulse la$a(e and satisfact!r) hem!stasis was

!tained after the t!urni.uet was released" The sec!nd metatars!phalan(eal 7!int was f!und t! e

intact with health) !$erl)in( tissue" There was n! further trac-in( laterall)" All s-in flaps

appeared t! ha$e (!!d capillar) refill"

The incisi!n was pac-ed with inch i!d!f!rm dressin( and c!$ered with ;luffs% A/D pads%