DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right forefoot diabetic foot abscess.
POSTOPERATIVE DIAGNOSIS: Right forefoot diabetic foot abscess.
OPERATION PERFORMED:
1. Incision and drainage of right forefoot diabetic abscess via the plantar approach.
2. First metatarsal head resection.
3. Bone culture.
4. Irrigation of said debridement.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
INTRAVENOUS FLUIDS: One liter.
ESTIMATED BLOOD LOSS: Minimal.
URINE OUTPUT: Not recorded.
OPERATIVE FINDINGS: See below.
CULTURES: Bone sent for aerobic, anaerobic, and fungal cultures.
DISPOSITION: The patient was extubated and transferred to the postoperative care unit in stable condition.
DESCRIPTION OF OPERATION: The patient was placed supine on the operating room table. After induction of anesthesia, the patient’s right foot was prepped and draped in standard surgical fashion.
The mal perforans ulcer over the first metatarsal head was cored out of devitalized tissue radially. A hemostat was placed along the tendon sheath of the first ray. The plantar skin was opened over this hemostat towards the heel, approximately 2 inches. The hemostat was then placed up the first phalanx, approximately 2 cm, and this tract was opened up. There was a lateral tract that went over but external to the tendon sheaths of the second and third metatarsal heads. This was obviously a former pus pocket. The first metatarsal head was then resected with a bone cutter and rongeur. Three liters of vancomycin-impregnated irrigation solution under pressure was then performed in this cavity.
At this point, all devitalized tissue was carved away from the lateral edges of the wound. On the dorsal aspect of the foot, there was only a thin layer of skin there that was viable. At this point, we then made a counterincision on the dorsal aspect of the foot to pass iodoform gauze through to clear a wick effect and continue any further drainage. At this point, we packed the entire wound from the plantar surface with iodoform gauze. We packed plantar surface of the wound with iodoform gauze. We sent a bone that was resected for aerobic, anaerobic, and fungal culture. We then wrapped the foot with Kerlix and an Ace bandage. The patient awoke from anesthesia finally and was transferred to the postoperative care unit in stable condition.
