DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Nonhealing left transmetatarsal amputation with gangrene.
2. Nonreconstructable atheroocclusive disease.
POSTOPERATIVE DIAGNOSES:
1. Nonhealing left transmetatarsal amputation with gangrene.
2. Nonreconstructable atheroocclusive disease.
PROCEDURE PERFORMED:
Right below-the-knee amputation with immediate-fit prosthesis.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old diabetic and renal failure patient, who developed gangrenous changes in the right foot. An attempt was made by another surgeon to perform a transmetatarsal amputation, which failed to heal. Angiography confirmed nonreconstructable disease from the ankles distally, and it was felt that primary below-the-knee amputation would be appropriate with immediate-fit prosthesis. The patient agreed and understood the risks, benefits, and other options.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed on the operating table in the supine position. After induction of anesthesia, the right leg was prepped and draped in sterile fashion. Intended incision line was mapped out approximately one hand’s breadth below the tibial plateau anteriorly with the posterior flap. A tourniquet was inflated on the thigh to 325 mmHg for hemostasis.
Incisions were then made along the marked skin down through the fascia. The muscles of the anterior compartment were divided with the scalpel, exposing the anterior tibial vessels. These were clamped and divided, oversewn with 3-0 Prolene. The fibula was then thoroughly mobilized using a periosteal elevator. Attention was directed medially, where the muscles of the posterior compartment were partially divided. Periosteal elevator was used to mobilize the tibia, and an oscillating saw was used to divide the tibia. A double action bone cutter was then used to divide the fibula approximately 1 cm above the level of the tibial transection. Amputation knife was then used to complete the amputation of the muscles, lateral and posterior compartment. The specimen was passed off the field. The posterior tibial and peroneal arteries and veins were identified, suture ligated individually with 3-0 Prolene. The tibial nerve was suture ligated with 3-0 chromics. Other muscular bleeding branches were suture ligated with 3-0 chromic with limited use of electrocautery. The anterior surface of the tibia was beveled and smoothed.
Tourniquet was then deflated, and additional small bleeding points were controlled with limited electrocautery and sutures. The anterior and posterior fascia were then approximated using 3-0 Vicryl. The skin was closed using staples. Clean sterile compressive dressing was placed followed by the immediate-fit prosthesis. The patient was then transferred to the recovery room.
