PREOPERATIVE DIAGNOSIS: Right ankle chronic lateral instability.
POSTOPERATIVE DIAGNOSIS: Right ankle chronic lateral instability.
OPERATION PERFORMED: Open Chrisman-Snook procedure.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, DO
ANESTHESIA: General with an endotracheal tube.
SPECIMENS: None.
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: None.
COMPLICATIONS: None.
TOURNIQUET TIME: Approximately 50 minutes.
DESCRIPTION OF OPERATION: After being properly identified by Anesthesia, in the same day surgery suite, the patient was transported to the operative theater. The patient was then transferred to the operating table and placed in the supine position. All bony prominences were well padded. The patient received 1 gram of preoperative antibiotics. After confirming the correct surgery site, which was confirmed to be the right ankle, the patient was put to sleep using a general endotracheal tube. A thigh-high tourniquet was placed on the patient’s right lower extremity. The patient’s leg was then prepped and draped in the usual sterile fashion.
A marking pen was used to delineate the incision at the lateral right ankle. The area was then injected with lidocaine. An Esmarch was then used to exsanguinate the right lower extremity. The tourniquet was inflated to 300 mmHg. The incision was made. This was approximately 15 cm in length, staying just posterior to the fibula and then curving distally around the lateral malleolus. The incision was then carried down to the level of the fascia. The sural nerve was then identified and protected throughout the entire case using a vascular loop. The peroneal tendons were then identified at their anatomical landmarks. This was just distal to the lateral malleolus. A knife was then used to free up both the peroneal brevis and peroneal longus tendons from the underlying scar tissue.
At that time, the peroneus longus was identified and a #10 scalpel was used to dissect this tendon in half. The tendon stripper was then used to dissect a portion of the peroneal longus tendon. At that point, all muscle was removed from the tendon and a marking suture was then placed. Attention was paid to drilling the holes anatomically in the lateral malleolus and the calcaneus, fused and sutured. Tendon passers were used to pass the graft through these tunnels, which were created using the bur on the lateral aspect of the ankle. The tendon was then brought through these tunnels and wrapped around the remaining portion of the peroneus longus tendon with good fixation. At that point, testing showed that the ankle was tight, free of any instability. The tendon was then sutured down using 0 Vicryl sutures. The tendons were shown to be in their anatomic position and showed again that the ankle was tight.
At that time, the sural nerve was then placed back in its anatomical landmark with attention paid to the lateral ankle to suture the subcuticular layer of skin back using 3-0 Vicryl sutures. The superficial layer of skin was sutured back using a 4-0 Monocryl. This was done in a running fashion. Steri-Strips were then placed over the incision to approximate it. The wound was then dressed with Adaptic, sterile 4x4s, and sterile Webril. It should be noted that a posterior splint was then applied to the patient’s right lower extremity with the ankle in neutral position. This was done using plaster of Paris, and two 4-inch Ace wraps were used to hold the splint in place, again making sure that all bony landmarks were well padded. The tourniquet was then let down and the patient was extubated. The patient was then taken to the PACU and noted to be in stable condition.
