PROCEDURE:
1. Removal of hardware.
2. Use of amniotic membrane tissue allograft.

INDICATIONS FOR PROCEDURE: This is a 71-year-old female who had hardware placed in
her toe some 15 years ago. She has loosening of the hardware and the distal screw is backing out
causing hypertrophic callus on the dorsum of her IP joint of her left great toe. She wishes to have
the hardware removed. The risks and benefits of surgery have been explained and informed
consent obtained.
OPERATIVE NOTE: The patient was taken to the operating room and placed in the supine
position. Once adequate anesthesia was obtained, the left upper extremity was prepped and draped
in the usual sterile fashion. Esmarch was used to exsanguinate the limb and was tied proximally
as a tourniquet. A midline skin incision was created. Soft tissue dissection was carried down to
the hardware which is easily removed. The wound is copiously irrigated. The skin edges are
approximated with 3-0 nylon in a running fashion. Amniotic membrane tissue Matrix allograft
was injected. The wound was dressed with Adaptic, 4 x 4’s, Kling, and Ace wrap. Esmarch is
removed. The patient taken to recovery in stable condition. No complications. The patient
tolerated the procedure well.