Operative Report #2


DATE OF SURGERY: 07/29/2009

Right Achilles weakness secondary to excessive length of the tendon.

Right Achilles weakness secondary to excessive length of the tendon.

1. Right Achilles tendon debridement.
2. Right Achilles tendon shortening.

Mr. XXXXXX is a 35-year-old male, who presents with a history of right Achilles weakness after undergoing a percutaneous surgical repair.  The patient continues having chronic weakness and inability to have a powerful take-off. Therefore, at this point and after confirmation of having a healthy tendon, it was recommended to the patient to proceed with the surgery mentioned above as a way-to restore his original strength.  The pros and cons of surgery were discussed with the patient.  He seemed to understand the discussion and agreed to proceed with the plan.

On 07/29/2009, the patient was taken to surgery and after successful induction of a spinal anesthesia he was placed supine on the operating table.

The right lower extremity was prepped and draped in a sterile fashion. After exsanguination by gravity, the tourniquet cuff was inflated to 250 mmHg along the proximal third of the right thigh.

Of note, both extremities were prepped and draped in a similar fashion as a way to compare the right foot to the left foot.

Through a medial approach along the most posterior aspect of the Achilles tendon we proceeded with incision of the skin. Subcutaneous tissues were dissected. The peritenon was incised, although was difficult to identify secondary to the previous scarring.

The Achilles tendon was identified and we proceeded with resection and debridement of the most anterior half of the Achilles tendon. The patient presented with an original width of the AP plane of approximately 8-9 millimeters.

Following this we proceeded with a Z-plasty, which was performed with a longer plane on the coronal plane exiting distally along the most anterior half of the Achilles tendon and proximal on the most posterior half.

Following this we proceeded with resection of another centimeter of both ends of the Achilles tendon as a way to be able to perform a side-to-side repair.

We proceeded with imbrication of approximately a total of 2 centimeters of Achilles tendon. This was done without complications. A side-to-side repair with fiber wire was performed with excellent results. This provided us with a resting position of approximately 10 degrees of plantarflexion with excellent tension across the Achilles tendon. Further dissection was performed as a way to release the scar tissue in between the most proximal portion of the Achilles tendon and remaining structures.

The tourniquet was deflated. The wound was closed in layers. Sterile dressings were applied. The patient was placed in a short leg cast in a resting position. The patient was transferred in sterile condition to the PACU.

The patient will remain toe touch weightbearing x 6 weeks. He will return to clinic in 2 weeks for suture removal. At that time he will be placed in a second short leg cast with slightly more dorsiflexion. At 4 weeks from surgery the patient will be brought into further dorsiflexion as required with a final goal of obtaining neutral alignment by the 6 week follow up appointment. If the patient almost reaches neutral at that 2 week appointment, the patient will remain in the cast with the hopes that he will reach neutral by the 6 week follow up. It would be better to error on too much plantarflexion than too much dorsiflexion during his early recovery time.

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