DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Gangrene of the right forefoot.
POSTOPERATIVE DIAGNOSIS:
Gangrene of the right forefoot.
PROCEDURE PERFORMED:
Right forefoot amputation and placement of wound VAC.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA:
General endotracheal.
ESTIMATED BLOOD LOSS:
Less than 10 mL.
FLUIDS:
700 mL of crystalloids.
SPECIMENS:
Right forefoot.
COMPLICATIONS:
None.
INDICATIONS FOR OPERATION:
The patient is a (XX)-year-old Hispanic female who is status post a right total knee replacement. During the course of this procedure, the patient suffered popliteal artery injury. She subsequently required a right femoral to below the knee popliteal bypass. The patient subsequently demarcated an ischemic area of her right forefoot. This failed to respond to revascularization with the femoral to distal popliteal. The patient was subsequently brought back to the operating room for a right forefoot amputation.
DESCRIPTION OF OPERATION:
After informed consent had been obtained and all risks and benefits had been discussed with the patient and the patient’s family, the patient was brought through same day surgery, where her remaining preoperative preparations were made. The patient was then brought to the operating room where she was placed supine on the operating table. General endotracheal anesthesia was administered per Anesthesia without difficulties, and the patient was intubated successfully. The patient was subsequently given 1 g of IV Ancef. Her right lower extremity was then circumferentially prepped with Betadine, and her right lower extremity was draped in the usual sterile surgical fashion using sterile towels and sterile drapes. A timeout was then completed confirming that the patient was present in the room for a right forefoot amputation.
A 10 blade was then used to make a circumferential incision down to the skin and underlying subcutaneous tissues, muscles, and tendons down to the bone at the line of demarcation of the forefoot. Periosteal elevator was used to elevate the periosteum anteriorly and proximally to the incision site. Bone saw was then used to transect the metatarsals and cuneiforms of the right forefoot. Metzenbaum scissors were used to transect the remaining tendon and ligamentous attachments. The forefoot was passed off the table as a specimen.
There was mild bleeding from the skin edges and newly exposed muscle bellies. The exposed cuneiforms and metatarsals were then debrided using rongeurs. The remaining necrotic muscle and tissue were removed sharply using a 10 blade. Hemostasis was then obtained using Bovie electrocautery. The wound was copiously irrigated with Polysporin antibiotic irrigation. Forefoot amputation was completed at the proximal portion of the metatarsal heads and the cuneiform metatarsal joint.
The wound was then dried, and a wound VAC was placed under sterile conditions in the operating room. The patient tolerated the procedure well without difficulties. A strong anterior tibial signal was dopplerable at the end of the case. The patient was extubated in the operating room and transferred to the PACU in good condition. Specimen was sent to Pathology for permanent section. There were no complications.
