DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Status post navicular body fracture with marginal osteophytes, right foot.
POSTOPERATIVE DIAGNOSIS: Status post navicular body fracture with marginal osteophytes, right foot.
PROCEDURE PERFORMED: Resection of osteophytes, dorsal surface of right navicular, with application of posterior mold.
SURGEON: John Doe, DPM
SEDATION: IV sedation local.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed up on the operating room table in the supine position. The correct site of surgery was identified, following which an intravenous sedative was administered. The proximal nerve block anesthetic was administered to the right foot and ankle utilizing a 0.5% Marcaine solution without epinephrine.
Next, the right leg and foot were prepared and draped in the usual aseptic manner. An Esmarch bandage was applied to her right forefoot and secured at the level of the right ankle; exsanguination and tourniquet ischemia. The following operations are performed.
Attention was directed to the dorsal and medial aspect of the right foot. An approximate 3.5 to 5 cm Z-type incision was made overlying the dorsal surface of the navicular. The incision was deepened through subcutaneous tissue. Small bleeding points were controlled with the monopolar Bovie. The subcutaneous tissues were then divided carefully to avoid any injury to the overlying neurovascular structures. The deep fascia was incised and retracted medially and laterally. The extensor tendons overlying the area were then elevated and retracted medially and laterally respectively.
Next, deep periosteal incision was made over the body of the navicular at which point severe dorsal osteophytes were identified, particularly at the more distal pole of the navicular. These were debrided with reciprocating power saw and bone rongeur. Sharp pieces of bone were then rasped and rongeured smoothly.
Inspection of the distal second cuneiform-navicular joint was inspected as well as talonavicular joint, and no overt arthritic changes were noted. A small quantity of bone wax was then applied to the cut surfaces of bone.
The deep fascia and periosteum were then reapproximated with interrupted sutures of 2-0 Vicryl, and the subcutaneous tissues were reapproximated with interrupted sutures of 5-0 Vicryl. The skin margins were reapproximated with several interrupted simple and vertical mattress sutures of 5-0 nylon. A small quantity of dexamethasone phosphate was instilled into the navicular cuneiform, into the navicular joints. The Esmarch bandage was released from the level of the right ankle. Circulation was promptly restored to within normal limits to the entire operated right foot and ankle, and hemostasis was considered satisfactory.
A primary sterile Xeroform dressing was applied to the skin incisions followed by several layers of fluff sterile gauze. A well-padded neutral position posterior mold was applied to the right lower extremity.
At the termination of the surgical procedure, the patient was then transported to the postanesthesia care unit in stable condition, and it was determined that she had tolerated the intravenous sedative, proximal nerve block anesthetic, and surgical procedures well.