DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Refractory and aggressive growth in plantar warts with history of renal transplant.
2. Irritated skin tags of the chest.
POSTOPERATIVE DIAGNOSES:
1. Refractory and aggressive growth in plantar warts with history of renal transplant.
2. Irritated skin tags of the chest.
PROCEDURES PERFORMED:
1. Shave excision, electrodesiccation and curettage, 14 plantar warts.
2. Excision, 3 skin tags.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: Local with sedation.
ESTIMATED BLOOD LOSS: Nil.
COMPLICATIONS: None apparent.
DISPOSITION: Same day surgery, in stable condition.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old Hispanic male who was bothered by recurrent refractory plantar warts. The patient has a history of a functioning renal transplant, and this actually is doing well. He has been treated for plantar warts in the past and had a poor response to CO2 laser ablation. After careful explanation of risks, benefits and alternatives, the plan was to perform major shave excision, electrodesiccation and curettage for plantar warts that were in the plantar aspect of his great and second toe as well as 12 other locations of his left forefoot. The patient has problems with the other foot; however, the left side is worse, and we elected to treat only one side at a time. The patient had growing lesions of the chest area that were pedunculated skin tags. After explanation of risks, benefits and alternatives, the patient agreed to proceed.
DESCRIPTION OF PROCEDURE: After verifying the plan and location and the limits of the procedure today, the patient was taken to the operating room and placed in the supine position. IV sedation was given. Metatarsal blocks were given to the great, second and fourth toe and then supplemented with local infiltration on the plantar aspect where plantar warts were involving the plantar surface. A total volume of approximately 20 mL of a combination of 0.25% Marcaine plain and Xylocaine 1% plain were infiltrated. Using a separate needle and syringe, the base of the skin tags of the chest were infiltrated as well. The area was widely prepared with Betadine paint and draped in sterile manner. Skin tags were excised and treated with wide electrodesiccation.
The lesions of the plantar foot and forefoot and toes were treated by shave excision, electrodesiccation, curettage and electrodesiccation again. Representative tissue was sent for permanent pathologic diagnosis; all of it appeared to be clinically typical for plantar warts. After completion, the areas were treated with bacitracin, Adaptic, light sterile dressing and Ace bandage. The patient tolerated the procedure reasonably well and was then transported to the recovery room in stable condition.
