DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Defunctionalized noncommunicating aneurysmal sac.
POSTOPERATIVE DIAGNOSIS:
Defunctionalized noncommunicating aneurysmal sac.
OPERATION PERFORMED:
Exploration and evacuation of chronic aneurysmal sac.
SURGEON: John Doe, MD
ANESTHESIA: Spinal anesthesia.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 1 mL.
INDICATIONS FOR OPERATION: This is a (XX)-year-old patient who developed footdrop two months ago and was noted to have swelling at the upper lateral aspect of the right leg. There is a history of right knee injection therapy for questionable arthritis. The patient has this 4 to 5 cm nonpulsatile, noninflamed mass at the lateral aspect and posterior to the head of the right fibula. There is diffuse dense mass extending to this laterally and superiorly. There is a chronic swelling in the area of the medial aspect of the thigh corresponding to the old aneurysmal sac, which is defunctionalized and noncommunicating as confined by arteriogram, which also shows patent right femoral-popliteal bypass graft. Doppler shows satisfactory flow to the right foot.
DESCRIPTION OF PROCEDURE: Under adequate spinal anesthesia, the operative site was prepped and draped in the usual fashion. Asepsis and antisepsis were observed. Preoperative antibiotics were given intravenously. A skin incision was made at the lateral aspect of the upper leg. The popliteal area, old brownish fluid was removed, which appears to be contents of a chronic aneurysmal sac. The fluid was noted to be communicating also superiorly and laterally where the swelling of the lower part of the thigh was noted.
With decompression of the fluid content, which is nonbloody but brownish, most likely contents of a defunctionalized noncommunicating aneurysmal sac, the swelling went down to normal. Medially, however, there still was swelling, which was likely thrombosed area of the aneurysmal femoropopliteal area.
After complete hemostasis, subcutaneous tissue and fascia were closed with 2-0 Vicryl interrupted and skin closed with subcuticular 4-0 Monocryl reinforced with Steri-Strips. At the end of the procedure, pressure dressing was applied over the thigh and the upper leg to prevent recurrence of fluid accumulation. No active bleeding was noted. The right dorsalis pedis Doppler signals were well heard. Estimated blood loss was less than 1 mL.
