PREOPERATIVE DIAGNOSIS: Painful 1st MCJ exostosis with oe!
l"in# #an#lion $"st on
%%%foot& POSTOPERATIVE DIAGNOSIS: Painful 1st MCJ exostosis with oe!l"in# #an#lion $"st on %%%foot& PROCED'RE: Exoste$to(" of the )o!sal %%% ta!so(etata!sal *oint+ %%%foot& S'RGEON,S-: %%% ASSISTANT,S-: %%% ANEST.ESIA: /o$al anestheti$ with (onito!e) anesthesia $a!e& PAT.O/OG0: Ex$ise) %%% $"st sent fo! s1e$i(en& MICRO2IO/OG0: None& .EMOSTASIS: Pneu(ati$ an3le tou!ni4uet& ESTIMATED 2/OOD /OSS: Mini(al& MATERIA/S: None& INJECTA2/ES: None& DRESSINGS: Stan)a!)& COMP/ICATIONS: None& PROCED'RE IN DETAI/: The 1atient !e$eie) 1 #!a( of An$ef 1!eo1e!atiel" an) un)e! (il) se)ation was 5!ou#ht into the o1e!atin# !oo( an) 1la$e) su1ine on the ta5le& A su!#i$al ti(e6out was then ta3en )u!in# whi$h the 1atient+ the su!#i$al site an) the 1!o$e)u!e we!e e!ifie)& A 1neu(ati$ an3le tou!ni4uet was then 1la$e) oe! 1a))e) 7e5!il a!oun) the %%%an3le& 8ollowin# int!aenous se)ation+ lo$al anestheti$ was infilt!ate) a5out the 1atient9s fi!st (etata!sal usin# %%%$$ of a 1:1 (ixtu!e of :; li)o$aine 1lain an) <&=; Ma!$aine 1lain& %%%foot an) an3le we!e then s$!u55e)+ 1!e11e) an) )!a1e) in the usual ase1ti$ (anne!& An Es(a!$h was utili>e) to exsan#uinate the %%%lowe! ext!e(it" an) the tou!ni4uet was then inflate)& Attention was )i!e$te) to the )o!sal as1e$t of the %%% (etata!so6$uneifo!( *oint+ whe!e a lon#itu)inal s3in in$ision was (a)e& The s3in in$ision was then )ee1ene)+ %%%at whi$h 1oint we note) a #an#lion li3e $"st oe!l"in# the exostosis& The $"st?5u!sa was $a!efull" ex$ise) an) sent to 1atholo#"& Disse$tion was $ontinue) )own to the $a1sule aoi)in# an" neu!oas$ula! st!u$tu!es& On$e the $a1sule was ex1ose)+ a lon#itu)inal $a1suloto(" was 1e!fo!(e) an) the $a1sule was !efle$te) (e)iall" an) late!all"+ ex1osin# the exostosis& A la!#e )o!sal exostosis was note) oe! the %%% ta!so6(etata!sal *oint+ whi$h was !e(oe) usin# an osteoto(e& The!e su!fa$e was fashione) usin# the a !on#eu! an) !as1& The *oint su!fa$es we!e exa(ine) an) foun) to hae %%% a!ti$ula! $a!tila#e&
The woun) was i!!i#ate) with $o1ious a(ounts of no!(al saline& The $a1sule was !ea11!oxi(ate) usin# @A6< Pol"so!5 sutu!e& The s3in was then $lose) usin# a !unnin# su5$uti$ula! a5so!5a5le sutu!e an) Ste!i6St!i1s& The in$ision was then )!esse) with 2eta)ine6 soa3e) A)a1ti$ $oe!e) with #au>e+ fluffs+ Blin#+ an) Co5an& The 1neu(ati$ an3le tou!ni4uet was then )eflate) an) 1!o(1t h"1e!e(i$ !es1onse was note) to all )i#its of the %%%foot& The 1atient tole!ate) the 1!o$e)u!e an) anesthesia well& %%% was t!ansfe!!e) to the Re$oe!" Roo( with ital si#ns ta5le an) neu!oas$ula! status inta$t to the 5ilate!al lowe! ext!e(it"&
8ollowin# a 1e!io) of 1osto1e!atie (onito!in#+ the 1atient will 5e )is$ha!#e) ho(e with inst!u$tions to eleate an) i$e when at !est& A(5ulation in su!#i$al shoe& Bee1 )!essin# $lean+ )!"+ an) inta$t until follow u1 a11oint(ent& Retu!n to $lini$ fo! 1osto1e!atie follow u1 in two wee3s& Call $lini$ if 1!o5le(s a!ise&