DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left foot neoplasm.
POSTOPERATIVE DIAGNOSIS: Left foot neoplasm.
OPERATION PERFORMED: Removal of left foot neoplasm.
SURGEON: John Doe, DPM
ASSISTANT: Jane Doe, DPM
ANESTHESIA: MAC with local consisting of 10 mL of 2% lidocaine plain and 0.5% Marcaine plain injected in a 1:1 mixture fashion, injected in a posterior tibial block and ankle block fashion.
PATHOLOGY: Left foot neoplasm, sent for pathological analysis.
HEMOSTASIS: Left pneumatic ankle tourniquet inflated to 250 mmHg.
ESTIMATED BLOOD LOSS: Less than 5 mL.
INJECTABLES: 10 mL of 1% lidocaine plain.
DESCRIPTION OF OPERATION: Under mild IV sedation, the patient was wheeled into the operating room and placed on the operating table in supine position. A well-padded left pneumatic ankle tourniquet was placed about the patient's left ankle. Before the ankle tourniquet was placed, the above-mentioned local anesthetic cocktail was injected into the left foot to achieve local anesthesia. The foot was then scrubbed, prepped and draped in the usual aseptic manner. The leg was elevated, and utilizing an Esmarch bandage, the left lower extremity was exsanguinated. The tourniquet was inflated and the surgery began.
Attention was then directed to the medial aspect of the patient's left arch where, overlying approximately the left navicular tuberosity, the soft tissue mass was palpated and outlined to be approximately 1.5 cm in diameter, circular in nature. Utilizing a #15 blade, an incision was made overlying the soft tissue mass in a lazy-S fashion, extending dorsal to plantar approximately 4 cm in length. Utilizing sharp dissection, the incision was then deepened down to the fascial layer and the skin was undermined distally and proximally from its fascial attachments. Care was taken to carefully retract all vital neurovascular structures. All bleeders were cauterized or ligated as necessary.
Once down to the fascial layer, a yellowish-appearing soft tissue mass consistent with the fascial surroundings was palpated and noticed to be well encapsulated and circumscribed from its neighboring fascial attachments. Utilizing a dissecting scissor, this soft tissue mass was dissected out of its fascial attachments and removed from the foot in toto. During this dissection, the patient was noted to have a mild sensation response to the area and the additional local anesthetic, as mentioned earlier, was injected into the area. All visible and palpable mass was removed from the left foot and was set aside for pathological analysis. Once the mass was removed, the underlying muscle belly was visible. The area was inspected for any more visual and palpable presence of soft tissue mass and there was none.
The area was then copiously flushed with normal sterile saline. The subcutaneous tissues were closed with 4-0 Vicryl and the skin was closed with 4-0 Prolene in a simple interrupted suture fashion. The incision was dressed with Betadine-soaked Adaptic, 4 x 4's, Kling, Kerlix, and an Ace bandage. The tourniquet was deflated and prompt hyperemic response was noted to the left lower extremity. The patient was then sent to recovery.