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Removal of Maxwell-Brancheau Arthroereisis Implants Operative Example

DESCRIPTION OF OPERATION: The patient was brought into the operating room and placed on the operating table in the supine position. Next, two well-padded pneumatic ankle tourniquets were placed bilaterally, and following IV sedation, general anesthesia was obtained. Local anesthesia was injected, approximately 5 mL, to the left foot and right foot. Bilateral feet were then scrubbed, prepped, and draped in the usual aseptic manner. At this time, the left foot was then Esmarched with an Esmarch bandage, and the left pneumatic ankle tourniquet was then inflated to 250 mmHg. Next, approximately a 2 cm incision was made on the lateral aspect of the left foot over the sinus tarsi, over the same eschars of the previous surgery. Incision was then deepened to the deep and subcutaneous tissues using sharp and blunt dissection. Care was taken to identify and retract all vital neurovascular structures. Next, a blunt dissection was carried down until the subtalar joint was identified and the MBA implant was then visualized. Next, utilizing a screwdriver from the MBA implant set, the implant was then removed with no problems. The area was then inspected for any areas of bone loss or damage; none was found. The wound was then flushed with copious amounts of normal sterile saline. Subcutaneous tissues were then reapproximated, coapted utilizing 3-0 Vicryl. The skin was reapproximated, coapted utilizing 4-0 nylon. The wound was then dressed with Xeroform, followed by 4 x 4s, followed by Kerlix. The left pneumatic ankle tourniquet was then deflated and prompt hyperemic response was noted to all digits of the left foot. The exact same procedure was done on the right foot as well. The tourniquet was then deflated on the right side, and prompt hyperemic response was noted to all digits of the right foot. The patient was then transferred to the recovery room with vital signs stable and vascular status intact to all digits of the left and right foot.

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