DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Status post puncture injury, left plantar central forefoot.
2. Abscess/cellulitis, left foot.
3. Complex foreign body, left foot.
POSTOPERATIVE DIAGNOSES:
1. Status post puncture injury, left plantar central forefoot.
2. Abscess/cellulitis, left foot.
3. Complex foreign body, left foot.
OPERATION PERFORMED:
1. Excisional debridement, left foot.
2. Removal of a complex foreign body, left foot.
3. Secondary wound closure over drains.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA-C
ANESTHESIA: General.
DESCRIPTION OF OPERATION AND FINDINGS: After satisfactory general anesthesia was obtained with the patient in the supine position, a pneumatic tourniquet was placed on the left proximal thigh with appropriate padding. The left foot, ankle, and leg were prepped and draped in the usual sterile orthopedic fashion using Betadine scrub and Betadine paint. The left lower extremity was elevated for several minutes and tourniquet inflated to 250 mmHg.
A longitudinal incision was made at the plantar aspect of the forefoot. We started distal at the puncture site and extended proximally between the first and second metatarsal fat pads. The area of puncture was ellipsed and the skin excised in a full-thickness fashion and removed. Deep dissection was carefully performed in a sharp and blunt fashion. Collection of purulent fluid was encountered, and a deep wound culture was taken for aerobic and anaerobic organisms and Gram stain. This area was evacuated. Deep dissection exposed a moderate amount of debris, which was consistent with thread-like fibers. Excisional debridement included skin, subcutaneous tissue, and musculocutaneous tissue. Deep dissection extended down to the fibular sesamoid. Limited debridement of the fibular sesamoid was performed superficially.
With the aid of FluoroScan and several small 27 gauge needles, the underlying broken needle was able to be localized. This was well deep to the fascia. Careful dissection was performed as guided with fluoroscopy. The complex foreign body was able to be localized and then removed. This was the proximal portion of a needle and corresponded exactly to what had been seen radiographically. This was removed. The wound was then irrigated with copious amounts of normal saline solution with bacitracin using pulsatile lavage. Additional inspection of the wound was carried out, ensuring that there was no residual debris or nonviable tissue. Wound appeared to be clean.
The wound was then carefully approximated using 4-0 nylon interrupted simple sutures. Two Penrose drains were placed, exiting at the proximal and distal margin of the wound. Sterile light compressive dressings were applied. Tourniquet was released with good perfusion of the foot noted. Foot was kept elevated. A regional ankle block was performed prior to application of dressing using a total 15 mL of 0.5% plain Marcaine solution. Anesthesia was reversed. The patient was transferred to the recovery room in stable condition. Instrument and sponge counts were correct. No complications.
