PROCEDURES:
1. First metatarsal head resection, left foot.
2. Bone biopsy of first metatarsal, left foot.
3. Layered closure of surgical wound, left foot.

MATERIALS: Gelfoam, 3-0 Vicryl and staples.
DRAIN: Jackson-Pratt drain.
SPECIMENS: Metatarsal head and bone biopsy of first
metatarsal.
ESTIMATED BLOOD LOSS: Less 50 mL.
COMPLICATIONS: None.
TECHNIQUE: After reviewing the patient’s history and physical and noting no significant changes since the patient’s last visit, the patient was brought to the operating room and placed on the operating table in supine position. In the presence of surgeon’s assistants, anesthesiologist, and nurses, a time-out was called to verify the patient’s name,procedure to be performed, and side on which it was to be performed. All present were in agreement. Following adequate IV sedation, a local anesthetic block was administered to the patient’s left foot in a standard Mayo-type fashion utilizing a total of 10 mL of 1% lidocaine plain. The patient’s foot
was then scrubbed, prepped and draped in the usual aseptic manner. Attention was then directed to the patient’s left foot where a previous hallux amputation was performed. Utilizing a hemostat, remaining staples were removed from the incision. The incision was opened and inspected. There was noted to be no devitalized tissue or purulence at this time. At this point, utilizing a sagittal saw, the first metatarsal head was resected and passed from the surgical field. It was sent
for pathology. The distal portion of the remainder of the first metatarsal was then resected with a rongeur and bone-cutting forceps and passed from the surgical field to be a clearance cut to rule out osteomyelitis. At this point significant bleeding was noted, which had not been noted on previous surgeries. No purulence was noted or devitalized tissue. Pulse lavage was then carried out utilizing 1 liter of saline mixed with antibiotics, followed by an additional liter of plain saline. Any redundant or devitalized tissue was resected, including both tibial and fibular sesamoid. The skin was then remodeled. Prior to closure of the wound, significant bleeding was noted. A Jackson-Pratt drain was placed along with Gelfoam. The deep structures were reapproximated with 3-0 Vicryl. Skin was reapproximated with staples. Adequate control of bleeding was noted with the drain in place. The foot was then cleaned and dressed utilizing antibiotic ointment, Owens silk, 4 x 4’s,
Kling, and an Ace wrap. The patient tolerated the above procedure and anesthesia well and was transferred from the operating room to the PACU with
vital signs stable and neurovascular status intact to the left foot.