Operation Report
I went to my surgeon for a routine 8th week checkup. He was extremely pleased with my progress and says my ROM was much better than patients he’ve seen who are approx. on the same timeline as I. I was very happy. I asked him why the scabs were still hanging onto the incision and I was getting frustrated that they weren’t falling off. So he took them off!!!!!!!!!!!!!! That was indeed a surprise for me. One little dot started bleeding so he put on a band aid. I was given the all clear to SUBMERGE my leg in water!!!!!!! Yay! I took a nice bath after getting home and it felt great having my leg under water. I also rubbed off the dead skin (like kkdub-snake skin indeed!) and overall the incision is looking good. I will post a pic later.
Here’s the report for those who may be interested:
Preoperative Diagnosis: Left Achilles’ tendon rupture.
Postoperative Diagnosis: Left Achilles’ tendon rupture.
Operative Procedure: Open repair of left Achilles’ tendon.
Anesthesia: General.
Indications: This is a 33-year old status post Achilles’ tendon rupture during soccer. She has weakness and clinical evidence of an acute rupture. She has listened to the risks and benefits of surgical and nonsurgical management and elects for surgical treatment. The plan is to treat this operatively on 06/18/08.
Findings: Complete rupture of the Achilles’ tendon treated with an open repair.
Description of Procedure: The patient was taken to the operating room and was placed in supine position on the operating room table. After adequate induction of general anesthesia, she was positioned in the prone position and the left lower extremity was prepped and draped in the usual sterile fashion. Prior to prep and drape, the opposite exttremity was examined to understand the resing tension on the Achilles’ such that this could be reproduced. A skin incision beginning at the levl of the calcaneus was extended along the medial border of the Achilles’ insertion in the midline and extended in a proximal direction for a total length of 12 cm. This was carried sharply through skin to subcutaneous tissue. The subcutaneous tissue was then carefully divided down to the level of the deep fascia. The Achilles’ tendon sheath was then entered. The 15-blade scalpel and Metzenbaum scissors were then used to open the tendon sheath for its entire length. It was noted that the sural nerve did traverse the area of the operative wound and this was carefully mobilized and care was taken to ensure that this was retracted from the operative field. (This is why I have the numbness in my foot).
The Achilles’ tendon was identified as a complete rupture. The rupture occured at approximately 4 cm proximal to the insertion to the calcaneus. There were no intact fibers present. The tendon ends were carefully identified and refreshed. The distal stump was a single unit and the more proximal stump was divided into a V-shape. This allowed for placement of two #5 Ethibond stitches in a Bunnell type fashion in the proximal stump, on in each limb of the V. The distal stump was similarly prepared with a #5 Ethibond in a Bunnell type fashion.
The wound was then copiously irrigated with sterile saline. The repair was then carried out wiht a 6 limb #5 Ethibond repair. The 4 limbs from the proximal stump were advanced distally grasping the distal stump, two medial and two lateral on the stump with a separation of approximately 1 cm. This allowed for overlap of the distal stump into the base of the V. The two limbs in the distal stump were then advanced out through the more proximal tendon.
The tendon ends were then overlapped such that the more distal stump seated deeply into the V shaped tendon tear and resting length was checked at this point. This advancement recreated the appropriate tension in the repair and all suture limbs were then firmly tied. This completed the repair. The resting length was restored. The repair was secure, and the wound was ready for closure.
Copious irrigation was performed with sterile saline. The tendon sheath was then closed over the tendon with figure-of-eight #1 Vicryl stitches. Care again was taken to avoid injury to the sural nerve. The subcutaneous tissue was closed with 2-0 Vicryl and a series of 2-0 nylon vertical mattress stitches were used for skin closure. The skin was then cleaned free of Betadine prep and a sterile dressing consisting of Xeroform gauze, dry gauze, and sterile Webril was applied. The drapes then were broken down and a posterior splint with side struts (wow, I’m a car!) made of plaster was applied and allowed to fully harden. The position of the foot was in plantar flexion at the appropriate resting length compared to the opposite side.
The patient was then returned to the supine position on her preoperative stretcher and was allowed to awaken from general anesthesia. She was then extubated without difficulty. She was transferred to the postanesthesia care unit in good condition.
there you go.