OPERATIVE REPORT
PATIENT: XXXXXX
REC: XXXXXX
PROCEDURE DATE: 02/16/2008
PREOPERATIVE DIAGNOSIS: Complete rupture of the left Achilles tendon. POSTOPERATIVE DIAGNOSIS: Complete rupture of the left Achilles tendon. OPERATIVE PROCEDURE: Left Achilles tendon repair. SURGEON: XXXXXX ASSISTANT: XXXXXX ANESTHESIA: General LMA with preoperative popliteal block. COMPLICATIONS: None. TOURNIQUET TIME: Under 1 hour. REPAIR UTILIZATION: FiberWire suture. PROCEDURE: The patient received 2 g of cefazolin in the preoperative holdingarea. Additionally, he received a popliteal nerve block from the anesthesia department. He was brought to the operating room and placed in the supineposition on the operating table. General anesthesia was induced. He was then placed in the prone position and scrupulous attention was paid towards patient positioning. There was a pre-prep done with isopropyl alcohol and then a formal prep and drape was done with chlorhexidine. Draping was done with scrupulous attention paid toward sterile technique. A posterior incision was marked on the region of the posterior medial border of the Achilles tendon. Esmarch exsanguination was utilized. The tourniquet was inflated to 250 mmHg. Sharp, blunt, and electrocautery dissection was taken down through the skin and soft tissues directly to the peritenon. The incision was taken just medial to the medial border of the Achilles tendon in an attempt to minimize disruption of the sural nerve. The peritenon was fully ruptured in the region of the rupture and was ruptured distally. The most distal aspect of the insertion of the Achilles tendon on its most distal half was intact and the more proximal aspect of the peritenon was intact and this was split in line with its fibers and preserved for further repair. Copious irrigation was done throughout the entire region. The tendon was extremely frayed, however, the frayed ends were preserved. The popliteus tendon was had been ruptured in a much more proximal location and remained attached at its more distal insertion of the calcaneus and this was preserved for further use. After copious irrigation and a minimal amount of soft tissue dissection, the proximal and distal ends of the tendon were whipstitched with two FiberWire sutures proximally and two sutures distally. The ends were tagged for further repair. The ankle was then placed in maximal dorsiflexion and plantar flexion. After evaluating range of motion, it was placed into plantar flexion for tying of the repair. The repair was then tied with the ankle in approximately 20degrees of plantar flexion which did not create any tension. The FiberWire sutures had excellent fixation, fit, and purchase. The foot remained in plantar flexion. Excess frayed portions were then reapproximated in an attempt to drape over the repair. The length of the plantaris tendon was then taken from its distal attachment where it was preserved and then woven through the distal and proximal segments and then draped over the proximal segment and fixed with 0 Vicryl suture. Again, copious irrigation was conducted. The peritenon was then reapproximated with 0 Vicryl suture in an interrupted manner from distal to proximal and from proximal to distal. There was acomplete lack of peritenon in the region of the rupture, however, this was approximated as best as possible. Following this repair, the tourniquet was released. Hemostasis was attained and a layered closure was done on the skin and soft tissues with 2-0 Vicryl suture and nylon interrupted suture. Dry sterile dressing was applied. The foot was splinted in plantar flexion and the patient was awakened, extubated and brought to recovery room in satisfactory condition having tolerated the procedure without difficulty.
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