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
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.