0%
TECHNIQUE VIDEO
0%
TECHNIQUE STEPS
 
0
0
TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute a surgical walkthrough

  • describe steps of the procedure to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
  • injury to sural nerve
  • injury to the lesser saphenous vein
F

Room Preparation

1

Room setup and equipment

  • standard OR table
  • this procedure is commonly performed as part of a SEMLS procedure (single event multilevel surgery)
  • may need a radiolucent table for the other procedures
  • tourniquet
  • right angle retractors

2

Patient positioning

  • prone for posterior incision
  • supine for medial incision
  • more conducive to doing concomitent procedures
  • patient is brought to end of table
G

Strayer Procedure

1

Makes either a posterior or medial incision

  • makes a 2- 2.5inch incision either posteriorly over the midcalf with the patient prone or medially with the patient supine
  • carry the dissection to the posterior fascia, which is then incised
  • do not confuse this with the gastrocnemius tendon

2

Protect the neurovascular structures

  • retract and protect the sural nerve and lesser saphenous vein
H

Fascia Lengthening

1

Divide the fascia

  • divide the fascia that overlies the superficial posterior compartment
  • place right angle retractor posterior to the gastrocnemius
  • this protects the saphenous vein and sural nerve

2

Identify the gastrocnemius tendon

  • identify the underlying tendon
  • identify the tendon of the gastrocnemius proximal to the conjoined tendon
  • identify the interval between gastroc tendon and the underlying soleus fascia
  • divide the fascia of the gastrocnemius transversly proximal to the conjoined tendon and leave the underlying muscle intact
  • gastrocnemius recession is done with a 15 blade

3

Test the lengthening procedure performed

  • test to see if the ankle can be dorsiflexed to ten degrees with the knee extended
  • it is essential that the hind-foot be inverted when performing this test
  • failure to do this will result in dorsiflexion coming from the foot (rather than the ankle) and will result in inadequate correction of equinus
I

Wound Closure

1

Perform a multilayer subcuticular closure

  • release tourniquet prior to closure and obtain hemostasis
  • the subcutaneous layer is closed with an absorbable 2-0 suture in a running locking layer
  • the skin is closed with a running, undyed absorbable monofiliament suture and steristrips
  • place in a cast with the foot in 5-10 degrees of dorsiflexion and inverted
Postoperative Patient Care
 

Please rate topic.

Average 5.0 of 1 Ratings

Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidences (1)
Topic COMMENTS (1)
Private Note