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Modified Chevron Bunionectomy Operative Example

DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed on the operating table in the supine position. Following IV sedation and 1 gram Kefzol, approximately 18 mL of 0.5% Marcaine plain and 1% lidocaine plain were injected in about the left bunion and first metatarsal region. The foot was then scrubbed, prepped, and draped in the usual aseptic manner. The left foot was then elevated and exsanguinated, and the left ankle tourniquet was inflated to 250 mmHg. Attention was then directed to the dorsal medial aspect of the left first metatarsophalangeal, where a 4 cm linear incision was made just medial to the extensor hallucis longus tendon. The incision was then deepened down to the level of the joint. A linear capsulotomy was performed exposing the medial prominence. There were mild tophaceous gout deposits along the metatarsal head and also along the medial aspect of the metatarsal, which were debrided. The medial aspect of the metatarsal was resected utilizing the oscillating bone saw. Incision was then deepened in the first interspace to the level of the adductor hallucis tendon, which was released from the base of the proximal phalanx and a 5 mm section of tendon was removed. The fibular sesamoid bone was then released distally, proximally and laterally. Good alignment of the hallux was noted with no lateral deviation. Attention was then redirected to the medial aspect of the first metatarsal where a V-shaped osteotomy was performed with apex distally, plantar arm going proximally and dorsal arm going superiorly. Upon completion of the osteotomy, the capsular fragment was distracted and shifted laterally, approximately 6 mm, and impacted upon the metatarsal shaft. A 0.045 inch K-wire was then used to temporarily fix the osteotomy. Next, using AO technique, a 24 mm 2.7 cortical screw was placed across the osteotomy running from dorsal, proximal, and distal plantar. The temporary K-wire was removed. Good fixation and alignment were noted clinically and radiographically. The remaining bone shelf was removed along the medial metatarsal utilizing oscillating bone saw. The incision was then flushed with copious amounts of saline and Kantrex. The periosteal and capsular tissue was reapproximated with 3-0 Vicryl. The skin was closed with 4-0 Vicryl and 5-0 Monocryl. The incision site was injected with 4 mL of 0.5% Marcaine and 1 mL of Decadron and Steri-Strips with Betadine-soaked Adaptic, Betadine-soaked 4 x 4's, fluffs, Kling and Coban were applied. The left ankle tourniquet was then deflated, approximately 40 minutes, with prompt hyperemic response to the left foot. The patient left the operating room to the PACU with vital signs stable. The patient is to remain partial weightbearing in postoperative shoe.

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