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Case study:

OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Equinus contractures secondary to spastic diplegia, bilateral

POSTOPERATIVE DIAGNOSIS: Equinus contractures secondary to spastic diplegia, bilateral

PROCEDURE: Bilateral percutaneous Achilles tendon lengthening.

ANESTHESIA: General via laryngeal mask.

DESCRIPTION OF PROCEDURE: The patient was placed on the operating room table, in a supine position and after adequate induction of general laryngeal mask anesthesia, both lower extremities were prepped and draped in the usual sterile orthopedic fashion. Pneumatic tourniquets were placed bilaterally about the upper thighs. First to the left lower extremity was addressed, where the leg was exsanguinated with an elastic Martin bandage, and a pneumatic tourniquet elevated to 200 mmHg. With the foot placed in neutral dorsiflexion of 90 degrees to his leg, a percutaneous stab incision was made at the distal end of the Achilles tendon along the medial side. The 15 blade knife was then used to cut the medial half of the tendon through the stab incision. A second stab incision was made on the medial side at the proximal pole of the tendon, approximately 7 to 8 cm proximal to the distal stab wound. Using a 15 blade,the tendon was cut through half its width through the stab incision. A third lateral incision was then made percutaneously midway between the proximal and distal incisions, and the lateral half of the tendon was cut through the stab wound incision. The foot could then be dorsiflexed 20 degrees above neutral with the knee extended. The wounds were then dressed with Mastisol and Steri-Strips followed by Xeroform, dry sterile dressing, and sterile Webril. The tourniquet was released with a total tourniquet time of 5 minutes.

Next the right leg was addressed, and an identical procedure was performed using three stab incisions cut distal and proximal along the medial half of the tendon with a lateral stab incision made midway between the two medial stab incisions. The lateral half of the tendon was cut. This foot was dorsiflexed 20 degrees with the knee extended and the wounds were dressed as on the other site. The tourniquet was also released with a time of 4 minutes.

Short leg casts were then placed with the feet in neutral position to the right and left side. Sponge, needle, and instrument counts were correct. The patient tolerated the procedure well and returned to the PACU in satisfactory condition.

ICD-10-PCS Code: Click here to enter text.