DATE OF OPERATION: MM/DD/YYYY
OPERATION PERFORMED: Repair of peroneal brevis tendon, left ankle.
DESCRIPTION OF OPERATION: The patient was brought from the short-stay unit to the operating room and placed on the operating room table in the supine position. At this time, the patient’s left lower extremity was elevated 60 degrees above the horizontal plane. Pneumatic thigh tourniquet was then placed. Following successful intubation, the patient’s left lower extremity was scrubbed, prepped, and draped. At this time, the patient was returned to the lateral position. An Esmarch bandage was then utilized to exsanguinate the patient’s left lower extremity. A pneumatic thigh tourniquet was then inflated to 350 mmHg.
At this time, attention was directed towards the patient’s left lateral ankle at the malleolar region, where a 7 cm hockey stick incision was then created just to pursue the patient’s lateral malleolus along the course of the peroneal tendons. The incision was then deepened down through the layers of subcutaneous tissue using sharp and blunt dissection and all venous tributaries were isolated and electrocauterized as encountered.
All the vital neurovascular structures were generally retracted in the medial and lateral fashion as well. Dissection continued down through the layers and the deep tissues. Peroneal retinaculum was identified and was incised appropriately. At this time, the tendon sheath of the peroneal brevis and longus tendons were identified and the tendons were palpated as proximally and as far as the incisions would allow. The tendon sheath was then incised in the longitudinal fashion along the course of the tendon, as far as the incision would allow.
At this time, it should be noted that sural nerve was identified and was retracted out of the incision site appropriately. As the incision continued, the peroneus brevis and longus tendons were identified accordingly. The peroneus brevis tendon course was followed inframalleolar where 5 cm multiple linear longitudinal tears were noted. The region of the tendon was isolated and all fibrotic and nonviable tendon was debrided.
Inspection of the tendon continued distally. The peroneus brevis was isolated and tubularized utilizing 3-0 FiberWire in a continuous running suture fashion. At this time, the proximal aspect of peroneus brevis and peroneus longus tendon were inspected as far as the incision would allow and was noted to be intact, white, and glistening in appearance. It should be noted at the area of longitudinal tendon, there was a tourniquet of fibrous tissue around the peroneus brevis tendon, which needed to be incised to allow for tendon release. The wound was then flushed with copious amounts of normal saline, which had been done periodically throughout the procedure.
Attention now was directed toward closure of the incision site, which consisted of 3-0 Vicryl in simple interlocking running suture technique for closure of the deep tissues including peroneal tendon sheath and peroneal retinaculum. A 4-0 Vicryl was then used for subcutaneous stitch and the skin was then closed utilizing skin staples with the skin being everted in a 60-degree manner before the skin staple was applied.
The left lower extremity was then dressed with a Jones compressive dressing with added posterior splint for stabilization. The foot was splinted in mildly plantarflexed and everted position to release any excess force on the peroneal tendon for further healing. The Jones compressive dressing consisted of alternating Webril and Ace bandages x3 layers after sterile dressings were applied to the left lower extremity consisting of 4 x 4s, 4 x 8s, 2-inch Kling, and Kerlix.
The patient tolerated the procedure and anesthesia well with successful extubation without complications, and the patient was then transported from the operating room to the recovery room with vital signs stable, vascular status intact to all aspects of patient’s left lower extremity.
