This is Dr Tomasz Budz DPM PGY-2 dictating an operative report for Dr

Goshko DPM for patient Ferraro, Heather, MR# 4410333, DOB

04/05/1973, DOS 01/08/2015.

Surgeon: Dr Goshko DPM

Assistant: Dr Tomasz Budz DPM PGY-2
Preop dx: Right foot plantar Fasciitis
Post op dx: Right foot plantar Fasciitis
Procedures: Right foot plantar fasciotomy
Abx: Preop Ancef 2g IVPB
Pathology: None
Anesthesia: MAC with local
Injectables:
-Preop: 10cc of a 1:1 mix of 1% Lidocaine plain and 0.5% Marcaine plain
-Postop: 4mg Dexathmethasone
Hemostasis: Right Ankle tourniquet inflated to 250mmHg
Sutures: 4-0 nylon
Implants: None
Complications: None
Findings: None

The patient was brought into the operating room and placed on the operating room table
in supine position. Patient was secured and well padded. A time-out was
taken with the Resident, Attending, circulator, anesthesiologist, and all
were in agreement to the patient, the procedure being performed, and the
location of the procedure. The pneumatic ankle tourniquet was then placed at the patients
well padded right ankle. Following adequate intavenous sedation, an infiltrated block of
the patient's right foot was performed utilizing 10cc of a 1:1 mix of 1% lidocaine plan
and 0.5% marcaine plain in a posterior tibial block type fashion. The patient's right lower
extremity was then scrubbed, prepped, and draped utilizing proper sterile technique. An
esmarch bandage was utilized to exsanquinate the patient's right foot, and the pneumatic
ankle tourniquet was inflated to 250mmhg. The following procedure was then performed.

Attention was directed to the right plantar medial aspect of the heel 2 finger widths
plantar to the medial malleolus. Next a linear incision approximately 2cm in length was
made perpendicular to the weight bearing surface inferior to the medial malleolus where
the dorsal and plantar skin meet. Next the tissue locator from the Koby Guard set was
used to bluntly dissect the area inferior to the plantar fascia. Then, the ligament separator
was used to bluntly dissect and isolate the plantar fascia. Finally the fascia separator was
used to further separate and isolate the plantar fascia. Once the plantar fascia was
isolated, the Koby Guard flex tip instrument and the single use blade were used to cut the
medial 1/2 of the plantar fascia. No other medial plantar fascial fibers were noted.

Following this, the operative site was flushed with copious amounts of sterile saline. The
skin was sutured with 4-0 nylon in a horizontal mattress fashion. The surgical site was
infiltrated with a total of 4mg Dexamethasone. The incision was cleansed with saline
soaked guaze and then dried. The incision was dressed with betadine soaked adaptic,
4x4's, cling, kerlix, and a coban wrap. The pneumatic ankle tourniquet was then deflated
and immediate capillary refill was noted to all digits of the patient's right foot. The patient
tolerated the anesthesia and procedure well. The patent was then transported from the
operating room to the recovery room with both vitals signs stable and neurovascular
status intact to the right foot. Following a brief course of postoperative monitoring, the
patient will be discharged home with specific written and oral instructions and will follow
up with Dr. Goshko in his private office within 1 week. This ends dictation for patient
Ferraro, Heather.