Operative Report Preoperative Explained for Students (Easy Guide)

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OPERATIVE REPORT Preoperative Diagnosis: 1) Subluxation, 2nd metatarsophalangeal joint, right foot 2) Hammer toe deformity, 2nd toe, right foot Post operative Diagnosis: Same Procedure(s) Performed: 1) Osteoplasty, 2nd metatarsal head, right foot 2) Arthroplasty proximal interphalangeal joint, 2nd toe, right foot A dorsolongitudinal skin incision, approximately 4 cm in length, was made extending from mid shaft of the 2nd metatarsal proximally to the base of the proximal phalanx of the 2nd toe distally. The skin and subcutaneous tissues were underscored and retracted. The incision was then deepened medial to the extensor digital and longus tendon and carried down to the level of the metatarsal head. The capsular and ligamentous structures then separated from the 2nd metatarsal head, and the 2nd toe plantar flexed, thereby bringing the 2nd metatarsal head into view. Utilizing a power saw and beginning at the surgical neck of the metatarsal head, a cut was made perpendicular to the shaft approximately one half the width of the metatarsal head and then beveled at a 45-degree angle to include the plantar condyles. The severed bone was then dissected out by sharp dissection, and all rough edges were rasped smooth. The right foot was loaded, finding good release of subluxation occurring at the level of the 2nd metatarsophalangeal joint but with considerable contractures still occurring at the proximal phalangeal joint of the 2nd toe. Therefore, two longitudinal ellipsing skin incisions were made directly over the head of the proximal phalanx of the 2nd toe. The created skin wedge was then sharply dissected. The skin and subcutaneous tissues were underscored and retracted. A transverse incision was then made through the capsule and extensor tendon complex at the proximal interphalangeal joint. The medial and lateral collateral ligaments were incised, and the head of the proximal phalanx was delivered. Utilizing a power saw, the head of the proximal phalanx was then resected, and all bony edges were rasped smooth. At the level of the 2nd metatarsophalangeal joint, the ligamentous and capsular structures were repaired with interrupted sutures of 2-0 Vicryl. Superficial tissues were then closed with 3-0 Vicryl, and the skin margins were approximated with interrupted horizontal mattress sutures of 4-0 nylon. Attention was then directed to the 2nd toe, where the extensor tendon and collateral ligaments were repaired with interrupted sutures of 3-0 Vicryl. Skin margins were then approximated with interrupted horizontal mattress sutures of 4-0 nylon. Before bandaging, the right foot was again loaded, finding a normally positioned 2nd toe. Signed Surgeon Signature Responses 28292-RT 28292-RT 28285-T6 28285-T6 28290-RT 28290-RT 28295-RT

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