DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left hallux valgus.
POSTOPERATIVE DIAGNOSIS:
Left hallux valgus.
OPERATION PERFORMED:
Bunionectomy with first metatarsal osteotomy, left foot.
ANESTHESIA: Local/MAC.
SURGEON: John Doe, DPM
ASSISTANT: Jane Doe, MD
HEMOSTASIS: Pneumatic ankle tourniquet at 250 mmHg.
ESTIMATED BLOOD LOSS: Less than 10 mL.
COMPLICATIONS: None.
PREPARATION: DuraPrep.
DESCRIPTION OF OPERATION: The patient was taken to the OR and placed supine on the operating room table. After 1 g IV Ancef and adequate IV sedation, a total of 25 mL of 0.5% Marcaine plain was injected above the first ray to achieve local anesthesia. The foot was then prepped and draped in the usual sterile manner. An Esmarch bandage was utilized to exsanguinate the patient’s left foot, and the ankle tourniquet was inflated to 250 mmHg.
Attention was then directed to the dorsomedial aspect of the first metatarsophalangeal joint where a linear longitudinal incision was made. Incision was deepened through the subcutaneous tissues using sharp and blunt dissection. Care was taken to identify and retract all vital neurovascular structures. All bleeders were ligated and cauterized as necessary. At this time, an L-type osteotomy was created at the medial aspect of the first metatarsal and first metatarsophalangeal joint. The capsular tissues were freed from the medial aspect of the first metatarsal head and onto the shaft of the first metatarsal.
At this time, attention was redirected to the first intermetatarsal space via the original skin incision. At this point, the conjoined tendon of the abductor hallucis was transected from the proximal phalanx. A lateral capsulectomy was then performed at the first metatarsophalangeal joint. Attention was then redirected medially where the prominent medial eminence was resected and passed from the operative field. At this time, a Z-type through-and-through osteotomy was created at the shaft and the distal metaphysial region on the first metatarsal. The capital fragment was then distracted and shifted into a more lateral position and impacted onto the first metatarsal.
At this time, position was checked under fluoroscopy and two 2.7 mm cortical Synthes screws were inserted from dorsal to plantar using standard technique. Excellent compression was noted. At this time, the residual bone shaft was resected and passed from the operative field. The wound was then irrigated with copious amounts of sterile normal saline. The capsular structures were closed with 2-0 Vicryl suture. Subcutaneous tissue was closed with 4-0 Vicryl suture, and skin with 4-0 nylon in horizontal mattress fashion.
Upon completion of the procedure, the incision was dressed with Adaptic gauze, and sterile compressive dressing was applied to the left foot. The foot was well padded and a forefoot cast was applied. The patient tolerated the procedure and anesthesia well and was transported to the PACU with vital signs stable. After a period of postoperative monitoring, the patient will be discharged to home with written and oral postoperative instructions.
