My Operative Report

Your surgeon will give you a copy of this if you request it. (It’s good to have for your records, etc..)

Date of Surgery: 02/11/2008
Preoperative Diagnosis: Left Achilles tendon rupture
Postoperative Diagnosis: Left Achilles tendon rupture
Operation: Open repair, left Achilles tendon rupture
Surgeon: XXXXXX, MD
Assistant: XXXXXX, MD
Anesthesia: General
Complications: None
Organs(s) Removed: Not dictated.
Estimated Blodd Loss: Minimal

Brief History: The patient is a 33-year-old gentleman who sustained an Achilles tendon rupture while playing basketball over this past weekend. We had met in the emergency room, and we had discussions regarding the operative and nonoperative management. Based on these discussions, he decided to proceed toward surgical intervention. The reasons for proceeding with surgery, the risks of the surgery, the benefits, and the complications were reviewed and discussed. He understands weakness, loss of motion, re-rupture are the main problems. Wound dehiscence, wound infection also issues with this type of surgery. He understands the recovery is about 1 year. He gave his informed consent, and we took him to the operating room today for stabilization of his Achilles tendon rupture.

OPERATIVE NOTE: The patient was brought to the operating room while supine on his hospital bed. General anesthetic was given without any difficulty. A pause was taken to confirm the correct operative site. A gram of Ancef antibiotic was given before the start of the operative procedure. He was then positioned prone. Bony prominence were appropriately padded. A tourniquet was placed on the left leg. The left leg was then prepped and draped in the standard sterile surgical fashion. An Esmarch bandage was used to exsanguinate the limb, and the tourniquet was inflated to 280 mmHg.

I made a standard posterior incision just off the border of the Achilles tendon. Skin and subcutaneous tissues were divided. The peritoneum was identified, elevated off of the Achilles tendon itself. The fracture site was identified, and clot was removed. We did a releasing incision through the peritenon on the more anterior surface of the peritenon to offer easier closure at the end of the case.

Once the end of the tendon was debrided we placed a #2 FiberWire Krackow suture in the distal stump. We then placed a #2 FiberWire suture in the proximal stump. We were satisfied with the purchase we had in each end of the tendon. We then repaired the tendon by tying the sutures together under appropriate amount of tension.

We had a good repair. We were able to obtain just short of neutral plantar flexion without undue tension, and we thought this was about equal compared to the contralateral side.

We took a #2-0 fiber for Vicryl suture and did an epitendious stitch around the area of the rupture. We then used a 2-0 vicryl suture to repair the peritenon over the ruptured tendon. There was 2-0 vicryl suture on the subcutaneous tissues and vertial mattress and horizontal mattress 3-0 nylon sutures were used on the skin after copious irrigation.

bulky dressings including Xeroform, 4 x 4’s, ABD pads, and cast padding were applied. A short-leg fiberglass cast was applied with slight plantar flexion. The patient was able to be awakened from the general anesthetic and taken to the recovery room in stable condition without any specific complications during the operative procedure. All counts were correct at the end of the case.


POSTOPERATIVE PLAN: The patient will go home from the hospital today. He will be nonweightbearing for the first 2 weeks. When he returns to my office in 2 weeks his sutures will be removed. We will place him into a short leg fiberglass cast, position neutral to the floor. He will be toe-touch to 20 lb weightbearing in that cast. he will then come back 2-3 weeks after for a Cam Walker boot placement. At that point in time, we will begin gentle active range of motion but no weightbearing without the brace. He can begin increasing his weightbearing status in the Cam Walker boot at that visit. He will then begin physical therapy at 6 weeks. Transition to normal shoe wear around 8 weeks after the surgical procedure.

10 Responses to “My Operative Report”

  1. thanks for posting Dennis..very interesting..especially the part about how he tied the two sutures together…makes sense. I’ll have to get my post op report at my visit in a few weeks.

  2. thanks for taking the time to post the report..Be interesting to get several so we can compare. Be great to post on the site. I will make sure to get mine and post.
    Have a great week.
    Doc Ross

  3. Dr. Ross,

    Thanks, looking forward to reading your operative report!

  4. Brendan,

    It’s great that you have many supportive family and friends around you. I think that’s really the key to everything. congrats! :D

  5. This is day two of post surgery. The nerve block that I had in my leg is wearing off and wow my leg is on fire. Can anyone please tell me when this pain subsides a bit? I have had acl repair, shoulder scope, knee scope, nine screws and a plate put in my ankle and so far this has been the worst pain yet. It’s frustrating!

  6. Keep up your pain meds and give your leg plenty of rest and elevation. This will make a big difference to your pain levels. The pain should ease over the first 2 weeks. A simple and effective pain med is 2 x 500mg paraceatamol every 6 hours. As far as getting back to work, this depends on what you do and how you can do it. Some people with desk jobs can get back in a couple of weeks. Best to talk to your doctor. You are in the frustrated, life turned upside down stage. Things get a bit clearer and better in a couple of weeks. There is plenty of support and information here so good luck with it all.

  7. Stuart,
    Thanks for your response! This site has been really helpful and has given me alot of insight on the injury. I have a desk job, so I am just going to have to play it by ear. So far the worst part of this post op is taking my leg down to use the restroom. The throbbing is unreal.

  8. Know exactly how you feel. It is normal and it took me about 2 weeks for it to completely go away. The pain medication I mentioned really worked and I knew exactly when I forgot to take them. I stopped taking the strong opiate type drugs early because they have bad effects. Most people think paraceatamol is just for headaches but my daughter (a nurse) told me how effective they are if taken every six hours. The important thing is no more than that. 8 per day is the max. If you get back to work early, take the time to put your leg up to reduce the swelling. Be prepared to have a few short days and build up in small steps. There is a tendancy in this early stage to think you can do things sooner than you should. Take the time while you are at home to research the injury and how ruptured tendons heal. I am sure you have done much of this already. A good understanding will help you when it comes to the things you should NOT do. The risk of re-rupture is greatest from when you start wearing shoes to about 12 weeks and will reduce from there. There are many ways doctors and physio’s treat this injury and it can be very confusing but even given the variety, most people have a good outcome. Those who do not have a good outcome, well it is generally because they did something they should not in the first 12 weeks or had a slip, mis-step or fall. Keep us posted.

  9. Stuart - That sounds like good advice. I re-ruptured mine recently at 11 weeks out from my first operation. I was a few weeks out from wearing shoes and my physio had advised I was good to go for a bike ride on the road. That was a bad idea. I re-ruptured it just trying to get on.

    I am now 5 weeks out from my second round of surgery and have just gone back into the boot but have noticed some numbness on the outside of my foot. I also get some occasional sharp pain in the same area. I think it must be nerve damage from surgery.

    Does anyone know if nerve damage from surgery can heal or if the numbness will be permanent?

  10. I tore my achilles 12-15-13 and had surgery 5 days later from an experienced surgeon. I’m 29 and very athletic, and never foreseen this injury happening. I opted for surgery, read it would work far better and also couldn’t imagine how my tendon would grow back together on its own and be at full strength.10 days after surgery I got put in a hard cast with a roll around. I’ll get out of the cast and most likely move to a boot in 4 weeks. I move my foot quite a lot inside my cast and work my foot around without feeling any real discomfort. I’ve read this is a real long process. Any advice on moving my foot? I have it casted at almost 90 degrees. Right out of surgery I also moved it and stretched it a little when possible. Which is why I think I was able to bend it that far in the first place. Any advice on what I’m doing and what to expect?

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