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Dr. Dennis Yenn's Major Surgeries - Op Report -
Hammertoe Arthoplasty w/ MPJ release & K-wire fixation
For educational purposes only, residents' use.
OPERATIVE REPORT (sample 2)
DATE OF SURGERY: 00/00/01
PRE-OPERATIVE DIAGNOSIS:
1. Hammertoe 2nd & 5th digits, right foot
POST- OPERATIVE DIAGNOSIS:
1. same
PROCEDURE(S):
1. Arthroplasty 2nd & 5th digits, right foot
2. capsulotomy release 2nd MPJ and K-wire fixation, right foot
3. Skin de-rotational plasty correction procedure, 5th digit, right foot
SURGEON: Dr. Dennis Yenn, DPM
PROCTOR: Dr. John Doe, DPM
RESIDENT(S): Dr. Your name, DPM (PGY2)
ANESTHSIOLOGIST: Dr. John Doe 2, MD
ANESTHESIA: Local with IV sedation (or general)
INDICATIONS FOR SURGERY, and HPI: see Podiatric H&P
FINDINGS:
1) Clinically rigid, non-reducible digits 2 & 5, right foot.
2) Associated hyperkeratoma dorsal digits 2 & 5, and 4th interspace, right foot.
3) Excessively wide head of proximal phalanx of 5th digit, right foot.
PROCEDURE IN DETAIL: Under mild sedation, the patient was bought into the operating room and assisted on to the operating table in a supine (or prone) position. A pneumatic ankle tourniquet was then placed about the patient’s right ankle. Following IV sedation, local anesthesic block was administered to the right foot appropriately utilizing a 1:1 mixture of 2% lidocaine plain and 1/2 % marcaine plain. The foot was then scrubbed, prepped, and draped in the usual aseptic manner. An esmarch bandage was then utilized to exsanguinate the patient’s right foot, and the pneumatic ankle tourniquet was inflated to 250 mm Hg.
Attention was directed to the 2nd toe of the right foot where a longitudinal incision was carried out dorsal to the toe and involved the contour of the deformity. Sharp and blunt dissection then carried down the the level of joint capsule with care taken to retract all vital neural-vascular stuctures. All bleeders were cauterized as necessary. Then a transverse tenotomy and capsulotomy as well as ligations of the collateral ligaments were performed at the proximal interphalangeal angle. The extensor digitorum longus tendon was then reflected proximally allowing the exposure and removal of the head of the proximal phalanx with an ossilating sagittal saw. The bone then passed from the operative site and sent for a pathological analysis. A power rasp smooths out the rough edges. Copious lavage was then applied with irrigation of normal saline.
At this time, a Killikian push up exam was performed at the 2nd MPJ and a contracture of this joint was noted. The original incision was then extended proximally in a serpentine shape. Sharp and blunt dissection carried down to the level of joint capsule with care taken to retract all vital and neural vascular structures. All bleeders were cauterized as needed. The follow steps were then performed: transverse tenotomy and capsulotomy, collaterals ligated, and then a McGlamry scoop was then used to free up plantar adhesions. The soft tissue reduction was noted to now be excellent. Copious lavage applied with irrigation of normal saline.
Attention was then directed to the 5th digit of the right foot where an elliptical incision was performed dorsal to the toe in the direction of: distal-dorsal-medial to proximal-plantar-lateral. The ellipsed skin was then passed from the operative site. Sharp and blunt dissection was then carried down to level of joint capsule with care taken to retract all vital neural, vascular structures. All bleeders were cauterized as necessary. A transverse tenotomy and capsulotomy as well as ligation of collateral ligaments were then performed at the level of proximal interphalangeal joint. The extensor tendon was then reflected proximally allowing exposure and removal of the head of the proximal phalanx with an oscillating sagittal power. The bone was then passed from the operative site to be sent for a pathological analysis. Power rasp then applied to smooth the rough edges, and irrigation applied.
Attention was then directed back to the 2nd toe where a K-wire was inserted and retrograded appropriately, crossing all joints of the 2nd toe including the MPJ to facilitate the reduction.
The extensor tendons were reapproximated, excess overhang cut and removed, and then coapted with absorbable sutures at the appropriate locations: 2nd digit PIPJ and MPJ, and 5th toe’s PIPJ. Deep structures were then reapproximated and coapted as well with absorbable 3-0 vicryl sutures. The skin then closed with non-absorbable 4-0 nylon (or prolene) sutures. The tourniquet was then deflated; prompt hyperemia was noted across all digits of the right foot. Local anesthetic 1/4 % marcaine plain as well as ½ a cc of cortisone (kenalog-10) was administered separately to the right foot.
The surgical sites were then dressed with xeroform, 4X4’s, kerlex and coban. Betadine ointment was applied at the K-wire site, and the K-wire then bent and color capped.
CLOSING STATEMENT: The patient tolerated the procedure and anesthesia well, left the operating room along with the anesthesiologist in stable condition. Following a period of post-operative monitoring, the patient will be discharged home per PAR (Post Anesthesia Recovery) with instructions to elevate both feet above the heart, take appropriate pain medications, keep dressing clean and dry, and to follow up with an appointment at Dr. Yenn’s clinical office.
PATHOLOGY SENT: bone from 2nd and 5th digits, right foot.
ESTIMATED BLOOD LOSS: Minimal
COMPLICATIONS: None
__________________
By Dr. Your Name, DPM
___________________
For Dr. Dennis Yenn, DPM
At the end of your dictation, please conclude with, “this ends the dictation report for patient’s name _______________. My name is Dr. your name dictating for Dr. Yenn. Please mail copies to all physicians listed in the beginning of the dictation including myself. Any questions please page me, Dr. Your Name at 555-555-5555. Thank you for you time.” Write down the report number for future reference.
Notes: be careful of numbers. For dictation purposes,
1) K-wires, say 0.062 (“zero point zero six two”), and not the way we commonly say it 6-2.
2) For 0.5% marcaine, say (“zero point five percent” or “half percent”).
3) For 2-0 Vicryl, say (“two hyphen zero”)
4) Dictate all doses and frequency, but DO NOT dictate amounts. Example: do NOT dictate “10 cc administered” or “tourniquet inflated to 275mmHg.
Importance of dictation:
1) serves as medical record keeping for future treatment(s)
2) serves as documented evidence for work done when billing or auditing.
3) legal defense for
a) amounts of medications administered
b) complications arisen with or without fault of OR.
Please fill out teaching form and have Dr. Yenn sign it before you leave (if your program requires it). Remember to give patients the Rx script for pain, and go over post-op instructions. The PAR should have a hardcopy of the handout titled, “Surgery Information for Patient.” Please stay at least 15 min after the patient has entered the PAR to make sure everything’s OK. Tell the patient if he/she has questions or concerns, call you (the resident). Then if necessary, the resident pages Dr. Yenn.
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click here for surgery info
Last update: 01/22/04, First update: 03/25/01.
home page: www.dyenn.com