OPERATIVE REPORT MORTONS NEUROMA PREOPERATIVE DIAGNOSIS: POSTOPERATIVE DIAGNOSIS: OPERATION: ANESTHESIA: SURGEON: ASSISTANTS: HEMOSTASIS: ESTIMATED BLOOD

D LOSS: MATERIALS: PATHOLOGY: 1. Mortons Neuroma, Right Foot 2. Hammertoe deformity, 4th toe Right foot SAME 1. Excision of Neuroma, Right foot 2. Arthroplasty of PIPJ, Right 4th toe Local with IV sedation Dr Cohen Dr. Stoll, Dr. Allen PNEUMATIC ANKLE TOURNIQUET MINIMAL None Bone, soft tissue mass

OPERATIVE PROCEDURE: The patient was brought to the operating room and placed on the operating table in the supine position. A pneumatic ankle tourniquet was then placed on the patients Right ankle. Following IV sedation local anesthesia was obtained utilizing 10cc of a 1:1 mixture of 1% lidocaine plain and 0.5% Marcaine plain. The foot was then scrubbed, prepped, and draped in the usual aseptic manner. An Esmarch bandage was then utilized to exsanguinate the patients Right foot and the tourniquet was inflated. 1. Excision of Neuroma, 3rd interspace, Right foot: Attention was directed to the Right 3rd interspace where a 3 cm linear incision was made. The skin was reflected and dissection was carried down to the deep transverse metatarsal ligament through blunt and sharp dissection. All Neurovascular structures were reflected, cauterized, or ligated as needed. The deep transverse metatarsal ligament was then transected and a large fibrous looking mass was visualized. The mass was at least 2 cm in size and contained three stalks, two of which were directed distally and the other proximally. The mass was then sectioned at the stalks and sent to pathology. Following copious irrigation, 4 mg of dexamethasone was injected into the remaining stalks and area to prevent stump neuroma and the operative site was closed with skin sutures only. 2. Hammertoe correction, right 4th toe: Attention was directed to the 4th digit where a 2 converging 2 cm semielliptical longitudinal incision was made over the dorsal aspect of the Proximal interphalangeal joint of the digit. The incision was then deepened through the subcutaneous tissues with care to retract all neurovascular structures. The ellipse was removed with sharp and blunt dissection. All bleeders were cauterized and ligated. A transverse tenotomy and capsulotomy was performed to the proximal interphalangeal joint of the 4th digit of the Right foot. The head of the proximal phalanx was then freed of its soft tissue attachments. A double action bone cutter was then used to resect the head of the proximal phalanx and was then passed from the operating room table. The phalanx was then smoothed of its rough edges with a bone rasp. The wound was then flushed with copious amounts of sterile saline and the extensor tendon was reapproximated with 3-0 vicryl. Skin was reapproximated with 5-0 Nylon. Upon completion of the procedure, a total of 2-3cc of an 8:2 mixture of 0.5% Marcaine and Decadron was infiltrated around the surgical site. The incisions were dressed with Betadine soaked adaptic and covered with sterile compressive dressing such as four by fours and kling. The tourniquet was then deflated and immediate hyperemia returned to all digits. The foot was then ace wrapped. The patient tolerated the procedure well and was transferred to the recovery room with all vital signs stable and vascular status intact to the feet. Following postoperative monitoring the patient will be discharged and given instructions and prescriptions, which were discussed, prior to the surgery.