Peroneal Tendon Debridement
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Procedure Outline
Table of Contents
- IV antibiotics were administered, and a popliteal and saphenous nerve blocks were placed.
- Patient was placed in supine position.
- General anesthesia was administered, and a tourniquet was placed on left upper extremity.
- The patient was then turned onto a lateral position and a beanbag (deflated with a vacuum) held the patient in this position.
- Standard sterile prep and draping of the left lower extremity was done.
- The peroneal nerve of the left leg was padded, and the medial prominences of the lower extremities were padded with foam.
- A curvilinear incision was marked out over the posterolateral aspect of the fibula following the path of the peroneous brevis tendon.
- The foot was then exsanguinated using an Esmarch bandage, and the tourniquet was inflated.
- The incision was made from approximately 4 cm above the distal tip of the patient's medial malleolus to the level of the tip of the medial malleolus.
- Great care was taken not to injure the peroneal nerve. Once it was identified, it was swept inferiorly and posteriorly.
- Soft tissue dissection was performed down to the retinaculum of the peroneal tendons.
- Sharp dissection was used to open this retinaculum. Within the retinaculum there was a significant amount of inflamed tenosynovium surrounding the peroneal tendons. Also a low-lying muscle belly of the peroneus brevis was present. This extended down through the retinaculum to the level of the inferior fibular groove.
- The tenosynovium was debrided back and the low-lying muscle belly was resected to a level above the start of the fibular groove.
- Peroneus quartus was also debrided.
- Inspection of the fibular groove showed that it was shallow and almost flat. The tendons showed good stability within the groove even with dorsiflexion and eversion.
- Three woven sutures were then passed through the bone to fashion the retinaculum back to the posterior portion of the fibula. This was then oversewn with 2-0 Vicryl sutures.
- The peroneal tendon excursion was tested in the reconstructed groove and retinaculum. There was no catching. Free excursion of the tendons was noted.
- The wound was thoroughly irrigated and the skin was then closed in layered fashion.
- The wound was then cleaned and dressed using Xeroform, fluffs, and Webril.
- A posterior short leg plaster splint was applied in neutral position.
- The tourniquet was released, and the splint held in place until its hardening.
- After emergence from general anesthesia, the patient was extubated by the anesthesiologist and taken to the postanesthesia recovery unit.
