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

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidences (1)
Topic COMMENTS (0)
Private Note