Tanesha Butler
Member
I'm not very experienced with the more difficult orthopedic cases. I'm getting just unlisted for the tendon transfers and not sure about the capsulorrhaphy. Can anyone help with this one? Any help would be appreciated.
POSTOPERATIVE DIAGNOSES: Left great toe cockup deformity and third
crossover toe with dislocated MTP joint.
PROCEDURE: Left extensor hallucis longus to first metatarsal tendon
transfer, extensor hallucis longus to extensor hallucis brevis tendon
transfer, inspection of integrity of flexor hallucis brevis and then third
toe MTP joint capsulorrhaphy and extensor tendon lengthening, flexor tendon
to extensor hood tendon transfer.
ANESTHESIA: General plus local.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room,
general anesthetic administered, airway secured, a well-padded thigh
tourniquet was applied. The leg aseptically prepped and draped in a manner
to ensure a sterile field. Timeout process was completed. Attention
turned towards the third MTP joint. Longitudinal incision made, sharp
dissection taken down through skin and subcutaneous tissue. A
Z-lengthening done on the extensor tendon. Deep capsular release performed
to mobilize the metatarsophalangeal joint and release its contracture.
Attention then turned plantarly where a 2-incision approach was used to
harvest the flexor long tendons from a distal incision, transfer them into
a more proximal incision and then down to the extensor hood where they were
tenodesed with 2-0 Vicryl. The extensor tendons repaired and ___ in
position with 2-0 Vicryl. The skin closed with 2-0 Vicryl for the
subcutaneous and nylon for the dermis. Attention turned towards the prior
tibialis anterior repair, longitudinal incision was made through a previous
incision site. Sharp dissection was taken down through skin and
subcutaneous tissue. The tendon appeared to be tenodesed well into the
medial cuneiform. The attention was then turned distally where her prior
bunion incision was used, sharp dissection taken down through skin and
subcutaneous tissue. The flexor hallucis brevis found to be attenuated but
still functioning. The prior transfer of the flexor hallucis longus found
to be intact. The extensor hallucis longus harvested the distal end
tenodesed to extensor hallucis brevis with FiberWire. The proximal end
shortened and then transferred through a drill hole in the first metatarsal
and then secured back to itself using FiberWire. The wound was irrigated
and closed with Vicryl and nylon. Sterile dressings and well-padded,
well-molded 3-sided splint applied and the patient transferred to recovery
stable, having tolerated the procedure well after local infiltration with
0.25% Marcaine plain.
POSTOPERATIVE DIAGNOSES: Left great toe cockup deformity and third
crossover toe with dislocated MTP joint.
PROCEDURE: Left extensor hallucis longus to first metatarsal tendon
transfer, extensor hallucis longus to extensor hallucis brevis tendon
transfer, inspection of integrity of flexor hallucis brevis and then third
toe MTP joint capsulorrhaphy and extensor tendon lengthening, flexor tendon
to extensor hood tendon transfer.
ANESTHESIA: General plus local.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room,
general anesthetic administered, airway secured, a well-padded thigh
tourniquet was applied. The leg aseptically prepped and draped in a manner
to ensure a sterile field. Timeout process was completed. Attention
turned towards the third MTP joint. Longitudinal incision made, sharp
dissection taken down through skin and subcutaneous tissue. A
Z-lengthening done on the extensor tendon. Deep capsular release performed
to mobilize the metatarsophalangeal joint and release its contracture.
Attention then turned plantarly where a 2-incision approach was used to
harvest the flexor long tendons from a distal incision, transfer them into
a more proximal incision and then down to the extensor hood where they were
tenodesed with 2-0 Vicryl. The extensor tendons repaired and ___ in
position with 2-0 Vicryl. The skin closed with 2-0 Vicryl for the
subcutaneous and nylon for the dermis. Attention turned towards the prior
tibialis anterior repair, longitudinal incision was made through a previous
incision site. Sharp dissection was taken down through skin and
subcutaneous tissue. The tendon appeared to be tenodesed well into the
medial cuneiform. The attention was then turned distally where her prior
bunion incision was used, sharp dissection taken down through skin and
subcutaneous tissue. The flexor hallucis brevis found to be attenuated but
still functioning. The prior transfer of the flexor hallucis longus found
to be intact. The extensor hallucis longus harvested the distal end
tenodesed to extensor hallucis brevis with FiberWire. The proximal end
shortened and then transferred through a drill hole in the first metatarsal
and then secured back to itself using FiberWire. The wound was irrigated
and closed with Vicryl and nylon. Sterile dressings and well-padded,
well-molded 3-sided splint applied and the patient transferred to recovery
stable, having tolerated the procedure well after local infiltration with
0.25% Marcaine plain.