DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right leg posterior tibial tendinitis with synovitis as well as tear in the tendon.
POSTOPERATIVE DIAGNOSIS: Right leg posterior tibial tendinitis with synovitis as well as tear in the tendon.
OPERATION PERFORMED: Repair of posterior tibial tendon tear and excision of any avascular bone and excision of synovitis.
SURGEON: John Doe, DPM
ANESTHESIA: General.
HEMOSTASIS: Right thigh tourniquet.
ESTIMATED BLOOD LOSS: Less than 5 mL.
INJECTABLES: 12 mL of 0.5% Marcaine plain.
MATERIALS: 5-0 Prolene, 3-0 Vicryl.
PATHOLOGY: Both synovial fluid and tendon were sent for gross pathology.
DESCRIPTION OF OPERATION: Under mild sedation, the patient was brought into the operating room and placed on the operating table in the supine position. A well-padded right thigh tourniquet was then applied. Following IV sedation, the patient was then placed under general anesthesia. The right leg was then prepped, scrubbed, and draped in the usual aseptic manner. An Esmarch bandage was used to exsanguinate the right leg, and the pneumatic thigh tourniquet was then inflated to 300 mmHg.
Attention was then directed to the medial aspect of the right ankle where the posterior tibial tendon runs. An incision was made following the contour of the posterior tibial tendon as it passes behind the medial malleolus. The incision length was approximately 6 cm following the contour of the path of the posterior tibial tendon just posterior to the medial malleolus. The incision was then deepened through the skin and subcutaneous tissues using sharp and blunt dissection. Care was taken to identify and retract all vital neurovascular structures. All bleeders were cauterized and ligated as necessary.
Dissection was then carried down to the tendon sheath of the posterior tibial tendon. Sheath was then excised utilizing scissors traveling along both distally and proximally to the tendon. Upon exposure of the posterior tibial tendon on the right ankle, synovial fluid was noted and synovitis was also noted. At this time, there was no split in the tendon noted, but there were multiple large lumps along the course of the tendon that could be palpated and visualized.
At this time, utilizing scissors and #15 blade, all the synovitis was then excised from the tendon sheath. Two semicircular incisions were made intersubstance into the tendon, encompassing the defects and the nodules. Also, the tendon was noted to be hypertrophied, so this also allowed us to decrease the overall bulk size of the tendon. Following the excision of those two semicircular incisions, the bulbous area of the tendon was excised en toto.
Next, the wound was then flushed with copious amount of normal sterile saline. The tendon was then reinspected for any other splits or hypertrophied areas; none were found. The tendon was then tubularized utilizing a running suture consisting of 5-0 Prolene. The tendon sheath was then reapproximated and coapted utilizing 3-0 Vicryl. Subcutaneous tissues were then reapproximated and coapted utilizing 4-0 Vicryl. Skin was then reapproximated and coapted utilizing 4-0 Prolene. The wound was then dressed with Steri-Strips followed by Xeroform, 4 x 4’s, and Kling. The area was then blocked with 12 mL of 0.5% Marcaine plain. Pneumatic ankle tourniquet was deflated, and a prompt hyperemic response was noted to all digits of the right foot. The leg was then dressed with a Jones compression bandage, posterior splint, with an EBIce machine incorporated into the right ankle. The patient was then transferred to the recovery room with vital signs stable and vascular status intact to all digits of the right foot. The patient tolerated the procedure and anesthesia well.
