01474 Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer procedure)

Name of the Procedure:

Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (Strayer procedure).

Summary

Gastrocnemius recession, commonly known as the Strayer procedure, is a surgical operation performed to lengthen the gastrocnemius muscle (calf muscle). Anesthesia is used to ensure the patient feels no pain during the procedure.

Purpose

The procedure addresses conditions like chronic calf tightness or equinus deformity, where the calf muscles are excessively tight. The goals are to reduce tightness, improve ankle dorsiflexion (upward movement), and alleviate pain, enhancing overall mobility.

Indications

• Chronic calf tightness
• Equinus deformity
• Persistent discomfort or pain due to tight calf muscles
• Difficulty walking or running due to limited ankle movement
• Failure of conservative treatments like physical therapy or orthotics

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustments to current medications as advised by the physician
• Pre-operative assessment including physical examination and possibly imaging studies like X-rays or MRI
• Discussion of anesthesia options with the anesthesiologist

Procedure Description

1. Preoperative Phase: The patient is prepped and taken to the operating room. Anesthesia is administered, which could involve general or regional anesthesia such as a nerve block.
2. Surgical Phase:
   • An incision is made along the length of the gastrocnemius muscle.
   • The muscle fascia (connective tissue) is carefully cut to release tension and lengthen the muscle.
   • The incision is then closed with sutures.
3. Postoperative Phase: Patient is monitored as the anesthesia wears off.

Equipment and tools include surgical scalpel, retractors, sutures, and sterilized surgical instruments. Anesthetics (general or regional) ensure comfort and pain management.

Duration

The procedure typically takes about 1 to 1.5 hours.

Setting

The procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic or podiatric surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve injury
• Blood clots
• Anesthetic complications
• Scar tissue formation
• Recurrence of tightness or deformity

Benefits

Expected benefits include:

• Reduced calf muscle pain and tightness
• Improved ankle movement and flexibility
• Increased ability to walk and run without discomfort
• Enhanced overall quality of life Benefits typically become noticeable within a few weeks post-surgery.

Recovery

• Post-procedure care includes rest, keeping the leg elevated, and applying ice packs to reduce swelling.
• Pain management with prescribed medication.
• Physical therapy to gradually restore movement and strength.
• Full recovery can take several weeks to months, during which follow-up appointments are necessary.

Alternatives

• Physical therapy focusing on stretching and strengthening
• Orthotic devices to improve foot alignment
• Botulinum toxin injections to temporarily relax the muscles
• Pros and cons include non-invasiveness and varying effectiveness compared to surgical intervention.

Patient Experience

During the procedure, the patient is under anesthesia and should not feel pain. Post-surgery, discomfort and swelling are common but managed with medication and care measures. Physical therapy aids in a smoother and faster recovery, improving the overall outcome and comfort level.