Removal of Plantar-Hindfoot-Midfoot Bony Mass

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Radiographic templating

2

Execute surgical workthrough

  • describes the steps of the procedure to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • basic major orthopedic set
  • oscillating saw

2

Room setup and equipment

  • standard OR table
  • fluoroscopy

3

Patient positioning

  • place patient supine
  • place small bump under ipsilateral hip to internally rotate the leg
  • place a thigh tourniquet
G

Plantar Approach

1

Mark the elliptical incision around the ulcer

2

Make the incision

  • make a longitudinal elliptical incision around the ulcer or a portion of the ulcer

3

Excise the diseased tissue

  • excise the skin portion of the ulcer
H

Deep Dissection

1

Identify the vasculature

  • in the middle portion of the wound, identify the lateral plantar artery

2

Retract the lateral plantar artery to the medial side of the bony mass

3

Place retractors

  • use blunt and sharp dissection to place the retractors around the mass
I

Mass Excision

1

Isolate the mass

  • once the retractors are placed, delineate the mass

2

Remove the mass

  • remove the mass using a power saw or osteotome
  • the mass should be removed until the calcaneocuboid joint is exposed and the cuboid has been resected dorsal to the calcaneus
J

Tissue Sampling

1

Take bone cultures

K

Wound Closure

1

Obtain hemostasis

  • remove the tourniquet
  • elevate the limb
  • if soft tissue bleeding is present, use suture ligatures
  • place bone wax to control the bleeding of the cancellous bone

2

Perform a single layer closure

  • close the wound in a single layer using 2-0 nylon on large needles with a near far, far near stitch to reduce the amount of dead space

3

Dressings and immobilization

  • apply a bulky compression dressing
  • large burn dressings work well

4

Apply a short leg cast

Postoperative Patient Care
 

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