Operative Report

Here’s my operative report:

Date of Operation: 3/3/2008

Pre and Postoperative Diagnosis: Left Achilles Tendon Rupture

Anesthesia - General plus popliteal block

Time: Tourniquet time was 46 minutes using a thigh-high tournigquet at 285 mmHg.

Estimated Blood Loss:  Minimal

Complications: None

Indications:   The patient is a pleasant 31 year old gentlemen who sustained a left Achilles tendon rupture on 2/26/2008.  He has had serveral opinions adn after reviewing this with him, he has elected now to go ahead with surgical intervention in the form of the above named procedure.  The potential risks and complications of this intervention were discussed in detail.  He has good understanding and desires to proceed.   Consent was obtained.

Description of Operation: The patient received 2 grams of cefazolin IV preoperatively.   Left foot and ankle were identified as teh operative site, shaved and scrubbed with Hibiclens.   Operative site was confirmed and marked.   He had a popliteal block placed by the anesthesia team.   The patient was brought to the operating room and underwent smooth induction of general anesthetic.   Once a steady state of anesthesia was achieved adn his airway was secured, the patient was gently assisted to a prone position on the OR table.   A tourniquet had been placed proximally on his left thigh prior to his turning.   His left lower extremity was then scrubbed with Hibiclens and draped out sterilely.   I marked out a skin incision on the posterior medial aspect of his Achilles tendon with the center of the incision over the rupture site.   I then exsanguinated the patient’s foot, ankle and lower leg and then inflated the tourniquet to 285 mmHg.  

I incised the patient’s skin and dissected carefully down to expose the tendon sheath.   I thne opened up the tendon sheath along the line of the incision and tagged with 3-0 Vicryl suture so I could find it easily to repair it in the end.   I then found the plantaris to be intact.  

Once that was all identified I used a small scissor to remove organizing heatoma from the ends of the ruptured Achilles tendon.   It was a through and through rupture.   I then trimmed off areas of the tendon that had a small to no integrity left to it.   Once that was done, I irrigated this area out with copious amounts of saline.  

I then used a #2 FiberWire suture to do a modified Kessler type stitch through the distal arm of the Achilles tneond.   I then did a similar one up through the proximal arm of the ruptured achilles tendon.  Once that was done, the patient’s foot was plantarflexed and I tied the suture down snugly.   I then used a 2-0 Vicryl suture to do a running circumferential stitch around the Achilles tendon.   I then divided the plantaris proximally and did weave up into the proximal Achilles region.   I then irrigated the entire area out with copious amounts of saline.   I placed the patient’s ankle through a rane of motion and felt that we had a good repair.   I then closed the sheath with a 3-0 Vicryl  suture.   The skin was closed with 3-o Vicryl and 4-0 nylon suture.   The wound was then dressed with sterile Adaptic, sterile gauze and sterile Webril.   A well-paddded posterior splint was applied and held in place with a 4 inche and 6 inch Ace wrap.   THe tourniquet was then deflated and his digits pinked up nicely with capillary refill less than two seconds.   He was then gently transferred back to a supine position on his hospital gurney.   He was awakened from his anesthetic and transported to the post anesthesia care with stable vital signs.   Needle, sponge, and sharp counts were all corect.   There were no complications.

Responses

Brings on the chills every time
I read this!

Any idea why the block plus general? Just curious.

Colin - The block is for post-op pain management…it lasts ~24 hours. They have to do the procedure while you are awake so that you can tell them when they hit the right nerve. Here is a post in which I talk a little bit more about it and there is a link to the procedure: http://achillesblog.com/brendan/2008/03/07/surgery/

It is different than a spinal block, which is an alternative to general.

Hope your recovery is going well.

Thanks for the reply! I had the spinal instead of General. Instead of lasting 2 hours, it lasted close to 12. Really screwed me. I had to stay the night and get cathed. Not fun. Great job on your site. I’m less than weeks post-op so I’ll be rummaging through your site for good tips and info. Check out my work in progress. achillesblog.com/colinpd.

Thanks again,
Colin

my doc likes to use the popiteal block because it lasts 24 hours or so, and therefore reduces pain during the first day. Allows you go “get ahead” of the pain with other meds like percocet. I was really glad. had the option of the block plus I guess a sedative (being concious) but I chose general plus the block. I don’t want to know anything!!

Just had surgery this morning. Chose block plus general anesthia. Did not take effect until after surgery. Wow excruciating when I woke but they pumped me with dilaudin and followed with loratab. A few hours after home leg was numb and doing ok now. See what tommorow brings.

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