2. Operative Report
PREOPERATIVE DIAGNOSIS: Gangrene left foot
POSTOPERATIVE DIAGNOSIS: Gangrene left foot
OPERATION: Amputation of left 2nd, 3rd, and 4th toes with
excisional debridement of left foot
ANESTHESIA: LMA
DESCRIPTION OF OPERATIVE TECHNIQUE: The patient was brought to
the operative suite where general LMA anesthesia was induced. The
lower leg and foot were widely prepped and draped in sterile
fashion. The patient had an extensive area of gangrene involving
the dorsum of the left foot. The 3rd and 4th toes were completely
gangrenous, and the skin above and on the plantar aspect of the 2nd
toe was gangrenous as well. A sharp incision was used to remove all
dead tissue at the line of demarcation of what was alive and what
was not. The underlying 2nd, 3rd, and 4th metatarsals were
involved. The infection was transected somewhat proximally,
necessitating complete removal of the 2nd, 3rd, and 4th toes. A
portion of the skin of the plantar aspect of the foot was debrided,
because the skin was also nonviable. Fortunately, there was good
bleeding at the margins of the wound once the necrotic tissue was
fully debrided. This was controlled with electrocautery and 1–0
Vicryl LigaSure. The wound was copiously irrigated. Our intention
was to treat this initially with a wound vac, but because there was
bleeding that was worsened with application of wound vac, this was
abandoned, and the patient was treated with Surgicel followed by
sterile gauze fluff dressings and an Ace wrap. Throughout the
procedure, estimated blood loss was approximately 150 mL. She was
transported to the recovery room in overall stable condition and
tolerated the procedure well.
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