DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Retrocalcaneal exostosis/Haglund deformity, left heel, with enthesopathy tendo Achilles, left heel.
POSTOPERATIVE DIAGNOSIS:
Retrocalcaneal exostosis/Haglund deformity, left heel, with enthesopathy tendo Achilles, left heel.
OPERATION PERFORMED:
Retrocalcaneal exostectomy with repair of Achilles tendon/tenolysis.
SURGEON: John Doe, DPM
DESCRIPTION OF OPERATION: The patient was prepped and draped in the usual aseptic manner. The patient was placed under general anesthesia, was placed in a prone position and a tourniquet was inflated to 300 mmHg of pressure after exsanguinating the leg with a Martin bandage.
A curvilinear incision was made running from superior medial to plantar posterior lateral. Incision was deepened including help with the Bovie. Sharp and blunt dissection was carried down to the paratenon tendon apparatus of the tendo Achillis. A vertical incision was then made through the tendo Achillis down to the bone and the paratenon and tendo Achillis were split in half and retracted medially and laterally. Sharp and blunt dissection allowed visualization of the posterior aspect of the calcaneus on both the superior and inferior portion medial and lateral aspects. Hypertrophic bone was noticed throughout the area, especially on the posterior, superior and lateral aspects. The area was remodeled using a combination of sagittal saw and rotary bur. Once the adequate contouring was accomplished and the area was made smooth, it was checked with FluoroScan throughout the procedure. The area was palpated, and once the adequate contouring had been completed, the area was copiously flushed with saline irrigation. The tendo Achillis was palpated and noted scar tissue and fibrosis along the anterior aspect of the tendo Achillis.
A tendon debridement was then performed on the tendo Achillis, removing all sharp and fibrotic tissue from that posterior aspect, at which time the area was copiously flushed with an antibiotic GU irrigation. Fluoroscopic views were taken again to assure adequate positioning and alignment, at which time the tendo Achillis repair was accomplished using 2-0 Vicryl in a Krackow-type stitch. The Krackow stitch ran from superior to mid portion and then was tied and then a second Krackow stitch was started, running from mid portion to inferior aspect. Silk of interrupted sutures were also employed to close any deficits to the tendo Achillis on the inferior aspect. Prior to closure, after flushing the area, bone wax was introduced to cover the raw bony surfaces of the calcaneus to minimize the bleeding.
Once the tendon was coapted properly and foot was tested, Thompson test was normal and dorsiflexing the foot showed the tendo Achillis to be intact and functioning well. A spider washer, the medium size, was placed over the posterior central region of the calcaneus. This was checked with fluoroscopic views. A K-wire was introduced through the center to act as a guidepin and measurement for a cannulated screw. A #34 was selected and the cannulated screw was then driven into the washer and into the posterior aspect of the calcaneus allowing the compression of the spider washer against the tendo Achillis. It was able to secure and pass the tendo Achillis to the calcaneus without over compressing the area. Two-finger tightness was used. The area was checked again with fluoroscopic views. The area was copiously flushed once more. The subcutaneous tissues were then closed with 3-0 Dexon and then skin was coapted with staples. The tendo Achillis and paratenon were sutured as a unit just as they were dissected as one unit. Tourniquet was released.
The patient tolerated the procedure well. Decadron was injected peritendinous to the area. A compressive dressing was applied. Foot and ankle were placed in a gravity equinus position. A BK posterior splint/cast was applied to hold the ankle in position. Tourniquet was released. CFT was normal to toes and the patient was then given a femoral nerve block to render postoperative anesthesia. The patient tolerated the procedure well and left the OR in good condition.
