DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Nonhealing diabetic foot ulcer on the left fifth metatarsal.
POSTOPERATIVE DIAGNOSIS: Nonhealing diabetic foot ulcer on the left fifth metatarsal.
OPERATION PERFORMED: Debridement of left foot ulcer with amputation of fifth metatarsal.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
SPECIMENS REMOVED: Left fifth metatarsal and necrotic skin and subcutaneous tissue.
INDICATIONS FOR OPERATION: The patient has had a previous left fifth digit ray amputation. She presents with a chronic nonhealing ulcer to the lateral aspect of her left foot with exposed fifth metatarsal with documented osteomyelitis. The patient has a superficial heel ulcer as well as a small superficial ulcer of the metatarsal head of the left great toe. The patient has been on multiple antibiotics and has failed to heal these lesions. She has been taken to the operating room today for debridement and amputation of the fifth metatarsal.
DESCRIPTION OF OPERATION: After informed consent was obtained and all risks and benefits had been discussed with the patient and the patient’s family, preoperative preparations were made, and the patient was brought to the operating room where she was placed supine on the operating table. General endotracheal anesthesia was administered per Anesthesia, and the patient was intubated without difficulty. The patient was given 1 gram of IV Ancef.
The left foot was circumferentially prepped from the knee down and then sterilely draped with sterile towels and sterile drapes in the usual surgical fashion. A time-out was then performed by the operative team confirming that the patient was present in the room for debridement of a left foot ulcer with fifth metatarsal amputation. A #10 blade was then used to make a circumferential incision around the foot ulcer to include a small rim of normal skin down to the bone of the fifth metatarsal. Bovie electrocautery was used to continue dissection through the subcutaneous tissue and underlying tendons down to the fifth metatarsal. The skin and soft tissue was then excised using Bovie electrocautery and passed off the table. Hemostasis was then obtained using Bovie electrocautery.
Bone cutter was then used to transect the proximal and distal ends of the fifth metatarsal, and the fifth metatarsal was amputated at the cuneiform articulation and passed off the table. Rongeurs were then used to remove the remaining bone fragments. After the dissection was completed, the cuboid bone along with the lateral portion of the third cuneiform was exposed. The remaining distal aspect of the fifth metatarsal was removed using the rongeurs. Good hemostasis was obtained using Bovie electrocautery. All necrotic subcutaneous tissue, fat, muscle and tendon were debrided.
The wound was then pulsavac’d using 3 liters of normal saline mixed with bacitracin. The wound was then inspected. The wound was very clean. Hemostasis was once again obtained using Bovie electrocautery. The wound was then packed using a wet Kerlix covered with dry gauze and wrapped with Kerlix and secured in place using an Ace wrap. The patient tolerated the procedure well and without difficulties. The patient was extubated in the operating room in good condition and transferred to the PACU. There were no complications. The patient received 250 mL of crystalloid in the operating room. Estimated blood loss was less than 50 mL.
