DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Open right ankle joint infected foot and lower leg, nonsalvageable.
POSTOPERATIVE DIAGNOSIS:
Open right ankle joint infected foot and lower leg, nonsalvageable.
PROCEDURE PERFORMED:
Guillotine amputation of right BKA.
SURGEON: John Doe, MD
ANESTHESIA: General with 10 mL of 0.5% Marcaine plain.
ESTIMATED BLOOD LOSS: Minimal.
DISPOSITION: Stable to PACU.
INDICATIONS FOR PROCEDURE: The patient was consented for a right open below-the-knee amputation. This was secondary to a chronic infection in his right foot, open ankle joint, with purulent discharge. The patient is a diabetic with extremely high sugars, above the 500 range when he was seen in the emergency department. The patient has had this chronic wound on his leg for some time now, and it has only gotten worse, despite one attempt at a muscle flap. The patient understands that his right foot is nonsalvageable and has signed written consent stating that he understands the risks and benefits of the procedure.
DESCRIPTION OF OPERATION: After explaining the potential risks and benefits of the procedure to the patient, written consent was obtained. The patient was taken to the operating room by gurney and transferred to the operating room table in the supine position. Endotracheal tube was placed, and general anesthesia was induced. Time-out was performed confirming the patient, procedure, and site to be operated on. The patient was previously on vancomycin, so no additional antibiotics were given. The patient had a nonsterile tourniquet placed on his right thigh, and he was prepped and draped in the standard sterile fashion.
The right lower extremity was exsanguinated by gravity only, and tourniquet was raised to 350 mmHg. We then performed a circumferential incision, approximately 15 cm below the tibial crest, down to the level of the tibia. The tibia and the fibula were isolated, stripped of the periosteum, transected with power saw. The knife was then used to complete the transection of the soft tissue. The peroneal, posterior tibial, anterior tibial neurovascular bundles were isolated and tied off. The nerves were put on stretch and transected to allow them to retract back into muscle tissue. Suture ties and straight ties were used to achieve hemostasis as well as electrocautery.
Tourniquet was taken down. Total tourniquet time was 24 minutes. Additional hemostasis was achieved with electrocautery. An Adaptic was placed over the open wound followed by Betadine-soaked gauze, sterile gauze, Kerlix and two Ace wraps. The patient tolerated the procedure well without any immediate complications. He was awakened from anesthesia and transferred back to the PACU. He left the operating room in good condition.
