And I was winning…….

Date of Surgery: 3-6-8

Title of Operation:  1.Primary Repair, torn left Achilles tendon

                                   2.Vulpius Gastrocnemius recession, left

Anesthesia:   General

Procedure:

The patient was brought into the operating room theater, placed in the supine position upon the guerney, was then successfully intubated and placed onto general anesthesia.  The patient was then turned and placed in the prone position on the operating room table.  A pneumatic thigh tourniquet was placed in the proximal one third of the left thigh under which Webril padding was applied.  Left lower extremity was then prepped and draped with CholraPrep and sterile draping to provide a sterile field. The left lower extremity was the exsanguinated utilizing a sterile ace bandage, a pneumatic thigh tourniquet was insufflated to 300mg of pressure.

Attention was then directed to the posterior aspect of the left lower leg and ankle where a 13 cm linear and then lazy S incision from proximal medial , ending distal lateral, was made.  Dissection was carried down through the superficial fascia, down to deep fascia, and all bleeders were identified and coagulated utilizing electric-Bovie.  Immediately, a significant amount of hemorrhagic debris was identified.  Care was taken to try to maintain the cruciate crural fascia and the paratenon.  Dissection was carried down further, identifying hemorrhagic debris and once the cruciate crural fascia was incised, a significant amount of hematoma identified.  This was removed demonstrating a full, complete rupture of the tendo Achilles as well as the plantaris.  The devitalized tissue at the end of both sections of this tendon were debrided and then a Krackow suture was then placed within the proximal stump of the soleus muscle and gastroc aponeurosis.  This was from lateral to proximal, across and then distal medial.  This was then tethered and then dissection was carried out more proximally and a Vulpius gastroc recession to allow for additional length to be manufactured.  This allowed nice approximation of the tendionus edges.  The Krackow suture technique was then completed through the distal stump and then, once again, sutured upon itself.  Zero Vicryl was then utilized to augment this in a simple and cruciated type fashion medially, laterally, anteriorly and posteriorly.  The wound was then flushed with a copious amount of saline and kanamycin solutions.  The cruciate crural fascia was then reapproximated utilizing 3-0 Vicryl in a simple running fashion, the superficial fascia utilizing 3-0 Vicryl in a horizontal mattress fashion, the skin approximated using 4-0 Monocryl in a subcuticular manner.  A posterior splint was then applied in a slightly plantar flexed position and the patient was then rotated into a supine positon upon a guerney and the pneumatic thigh tourniquet deflated to note a pinkish return to all digits and the foot.   The patient was then taken from the operating room to the recoevery room in apparent satisfactory and awakening condition with vital signs stable and vascular status intact to all digits and left foot.  The patient will be followed up in our office postop.

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