Name of the Procedure:

Lengthening or Shortening of Tendon, Leg or Ankle; Multiple Tendons (through same incision)

Summary

This surgical procedure involves lengthening or shortening multiple tendons in the leg or ankle through a single incision. Tendons, which connect muscles to bones, may need adjustment to improve mobility and decrease pain or discomfort.

Purpose

Medical Condition or Problem: This procedure addresses tendon contractures, deformities, or imbalances due to conditions like cerebral palsy, muscular dystrophy, or tendon injuries. Goals/Expected Outcomes: The primary goal is to restore normal tendon length, improve joint function, correct deformities, alleviate pain, and enhance the range of motion in the affected limb.

Indications

Symptoms or Conditions: Limited mobility, chronic pain, visible deformities, difficulty walking. Patient Criteria: Typically, patients who have not responded adequately to non-surgical treatments such as physical therapy, orthotic devices, or medication.

Preparation

Pre-Procedure Instructions: Patients are usually advised to fast (no food or drink) for 8-12 hours before surgery. Medication adjustments, especially blood thinners, may be required. Diagnostic Tests/Assessments: Preoperative imaging studies such as X-rays or MRI, and a physical examination to assess the condition of the tendons and overall health.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered to ensure the patient is pain-free.
2. Incision: A single incision is made near the affected tendons.
3. Tendon Adjustment: Surgeons then either lengthen or shorten the tendons. Lengthening involves making tiny cuts in the tendon to stretch it, while shortening requires excising a portion of the tendon and reattaching the ends.
4. Closing the Incision: The incision is closed with sutures, and sometimes a cast or brace is applied to immobilize the area during healing.

Tools/Equipment: Scalpel, sutures, tendon stretchers or scissors, and surgical clamps.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and number of tendons involved.

Setting

This procedure is performed in a hospital operating room or a surgical center.

Personnel

Healthcare Professionals Involved: Orthopedic surgeon, surgical nurses, anesthesiologist, and sometimes a physical therapist for postoperative care.

Risks and Complications

Common Risks: Infection, bleeding, and swelling. Rare Risks: Nerve damage, blood clots, and issues with anesthesia. Possible Complications: Tendon rupture, loss of function, or incomplete resolution of symptoms. Most complications are manageable with appropriate medical interventions.

Benefits

Expected Benefits: Enhanced mobility, correction of deformities, pain relief, and improved quality of life. Realization Timeframe: Benefits are typically realized within weeks to months post-surgery, depending on the patient's adherence to rehabilitation protocols.

Recovery

Post-Procedure Care: Follow-up appointments for wound check and suture removal, pain management, and physical therapy. Expected Recovery Time: Approximately 6-8 weeks, with gradual return to activities over several months. Restrictions on weight-bearing and strenuous activities are common.

Alternatives

Other Treatment Options: Physical therapy, orthotic devices, medication for pain and inflammation, and minimally invasive procedures. Pros and Cons: Non-surgical treatments are less invasive with fewer risks but may not be as effective in severe cases. In contrast, surgery offers more definitive correction but comes with higher risks and a longer recovery period.

Patient Experience

During the Procedure: With anesthesia, the patient will not feel pain or be aware of the procedure. Post-Procedure Experience: There might be pain, swelling, and discomfort which can be managed with prescribed pain medication and proper care. Early stages involve limited mobility and gradual rehabilitation to ensure proper healing and function restoration.