{"text":"Mr Kumar \n01\/05\/2013 \nSECONDARY REPAIR OF ACHILLES TENDON AND FHL TRANSFER LEFT ANKLE \n: syth GIasgow Lanarkshire G65. 9PQ : Mr \u201denthllf Kumar : \nHospital No: ~ 10338654X D.O.B.: 08109\/1955 Ass:stant . MrSarti Roberts - \nIndication: 5 'g\u2018_fff)les Tendon Mrdsubstance Bupture , Anaesthetlst Dr Sbtona Stott e \n\u2018 ANAESTHETIC: SPINAL AND POPLITEAL BLOCK(SS) \nDVT prophylaxis: Aspirin 150mg for 6 weeks MEDIUM RISK \n\" Antibiotic prophylaxis: 1.5g cefuroxime iv \nPOSITION AND TOURNIQUET: Prone position. Thigh tourniquet. \nAPPROACH: Longitudinal midline incision, complete rupture with extensive scarring noted. Proximal retracted \nby 7-8cm, dissected upto the musculotendinous junction. Turn-down flap of medial third of the gastrocnemius \ntendon, sutured to the distal stump. FHL divided just distal to the fibrous tunnel and plugged into a drill hole over \nthe back of the os calcis in front of the Achilles tendon, held with a Biotenodesis screw. FHL muscle belly sutured \nonto the tendon. \nCLOSURE: 2,0 vicryl to the subcutaneous layers, with skin closure with clips. No drain was used. Below knee \nplaster in full equinus applied. \nPOST - OPERATIVE INSTRUCTIONS: \nRoutine observations CSM. \nMobilise when comfortable, partial weight-bearing. \nFollow up: Nurse-led clinic 10 days for change of plaster \nMAINATAIN FULL EQUINUS. \nSee in Mr. Kumar\u2019s clinic 4-6 weeks thereafter. \nSigned: \u2018 C. 8. 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