Esmarch bandage
arthroplasty
dorsal linear midline incision
interphalangeal joint
proximal interphalangeal joint
MTP joint
MicroAire Sagittal Saw
Austin bunionectomy
L-type capsulotomy
chevron or V-shaped osteotomy
K-wire (Kirschner wire)
Steinmann wire
Steinmann pin
capillary refillNote: This is only the Description of Procedure Portion of a report.... DESCRIPTION OF OPERATION: Following the induction of local infiltrative anesthesia at the base of the fourth toe on the right foot, and additional infiltrative anesthesia around the circumference of the first metatarsophalangeal joint on the right foot, along with intravenous supplementation, the patient's right foot and ankle were prepped and draped in the usual aseptic manner. The right foot and ankle were elevated to approximately 35 degrees while an Esmarch bandage was applied to the forefoot. The ankle tourniquet was then raised to approximately 250 mmHg pressure. The Esmarch bandage was released.The foot and ankle were then placed on the table in the horizontal position and arthroplasty, fourth digit, right foot, was performed. At that time, an approximate 1 to 1.5-cm dorsal linear midline incision was made directly over the fourth digit on the right foot. This incision extended about the base of the proximal phalanx down through and including the interphalangeal joint articulation. Dissection was then carried deeper through the subcutaneous tissue, identifying the long extensor tendon as it passed over the toe and this was then incised transversely to the level of the proximal interphalangeal joint. The tendon was then reflected off the head of the proximal phalanx ad the head was delivered by means of severing at the collateral ligaments. I then used a MicroAire Sagittal Saw to remove the head of the proximal phalanx. The long extensor tendon was then coaptated end to end with two simple interrupted sutures of 4-0 Vicryl. The skin was closed with 4-0 Prolene. Attention was then directed more medially, where an Austin bunionectomy of the first metatarsal, right foot, was performed. At that time, an approximate 3.5 to 5-cm dorsal linear longitudinal incision was made directly over the first metatarsophalangeal joint on the right foot. This incision extended from the distal 1/3 of the first metatarsal down through and including much of the length of the proximal phalanx. Dissection was then carried deep into subcutaneous tissues and any superficial bleeders encountered were electrocauterized and any neurological structures were preserved. The long extensor tendon was underscored and retracted laterally to gain entrance to the periosteal and capsular structures of the first metatarsophalangeal joint through a distal L-type capsulotomy. The capsular structure was removed from the joint adjacent side of the metatarsal and an elevator was then inserted beneath. I then used the MicroAire Sagittal Saw to remove a fair portion of the first metatarsal, medial aspect. I then the same MicroAire Sagittal Saw to make a typical chevron or V-shaped osteotomy with the proximal resection through the angular armature of the first metatarsal head from medial to lateral. The head was then shifted about 1/3 away and then temporarily fixated with 0.62 Kirschner wire. I then used a 0.62 Steinmann threaded wire and fixated the head to the first metatarsal shaft. The area was then flushed. The capsular structures were picked up and closed with simple interrupted sutures of 3-0 Vicryl. The subcutaneous structures were closed with a running suture of 4-0 Vicryl. The skin was closed with Steri-Strips. Upon completion of the procedure, the fifth toe was injected with about 0.25 mL o dexamethasone phosphate. The forefoot was then dressed with a dry sterile compression dressing with a Betadine underwrap and the ankle tourniquet was released. There was noted instantaneous capillary refill to the operative digits. The patient was then taken from the operating room to the recovery room and all vital signs were stable. The patient tolerated the surgery and anesthesia quite satisfactorily. Prior to surgery, the patient had been given the usual oral and written postoperative instructions, along with appropriate pain medications and followup appointment.
"Patients and Medical Transcription" at http://www.mt-stuff.com
If you do use these sample reports for students or classes, please let me know. My goal for this web site is to mentor future MTs to carry on our professional craft and legacy; I would like to know I helped in some small way to achieve that goal.
Thank you and May God Bless You,
Rosemarie
