Mackenzie Hawk Surgery Experience Page 1

One of the procedures I was able to observe during my surgery rotation was an

incision and debridement of the left foot with possible bone resection and bone biopsy.

The patient had presented to the ER two days prior with what the patient had thought

was a callus on the bottom edge of his left foot that had broken open and began

draining. This wound was determined to haven been secondary to the patient’s history

of type 2 diabetes mellitus. A wound culture ordered by the admitting physician

showed signi cant infection and subsequent necrotic tissue was found upon

examination. The purpose of the procedure was to rid the foot of all nonviable tissue

and biopsy the bone to determine if the infection had spread to the bone tissue.

Removing the necrotic tissue would help the body focus its healing intentions on the

tissue that had the greatest chance of survival.

The preparation started by having the patient be NPO except for his blood

pressure and kidney transplant medications that morning. Then the nurses on the oor

made sure his dentures, hearing aids, and all metal jewelry were removed prior to

transport down to the OR. I did not get to observe the CRNA put the patient under

anesthesia, but I did get to see the nurse prepare the incision site for the procedure. An

absorbent pad was placed under the left calf and foot rst. Then, the nurse opened a

sterile tray of cleaning supplies and put on a pair of sterile gloves. He then began to

pour an orange liquid (betadine) over the entirety of the foot and ankle. He used the

sponges in the sterile package to scrub the foot and ankle with the betadine before

using two sterile towels to remove excess liquid. He explained that normally for

laparoscopic and robotic procedures they use a di erent cleaning substance, but for
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open procedures such as this one, they must use the betadine. Next, the surgical

technologist began to set up the sterile eld and drape the patients foot, careful as not

to touch the area that was just cleaned. The CRNA continued to monitor the patient

behind the sterile drape to make sure that the patient was properly sedated. The

doctor and his physician assistant began the procedure after the nurse had done the

team brie ng, and they slowly began to chisel away at the dead tissue. Meanwhile, the

surgical technologist watched the procedure and anticipated any instrument that the

doctor may ask for. They used many di erent tools and drills to carefully take a section

of bone to give to the nurse for specimen collection. Then the doctor and his assistant

irrigated the wound with several minutes of pressurized solution. Next, they inspected

the wound for anything they may have missed, and began working together to close

the two openings they had created. Finally, the surgical technologist assisted the

podiatrist and his resident in dressing the foot and tearing down the sterile eld. The

nurse and the technologist once again when through the instrument and supply count

to ensure that nothing was missing, and then ended the procedure. Once the doctor

declared the nish, the CRNA slowly reversed the anesthesia, and the patient was able

to move and answer questions once it was time to transport him to PACU.

The nurse acted as the patient advocate in many ways before, during, and after

the procedure. Before the procedure, the nurse directed a team meeting with all of the

health care personnel to ensure that the correct procedure on the correct patient and

correct extremity was being done. Each instrument and supply was counted and

recorded so that it could be veri ed at the end of the procedure as well. Also, the nurse

placed a black safety strap over the patients midsection in order to make sure that the
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patient was secure during the excitement stage of anesthesia. He remained

professional and took care to be as clean as possible to prevent any further

complications of infection for the patient. He also kept up to date on the assessments

and documentation of the procedure. All in all, the nurse acted appropriately as the

team leader and director of the work ow, and I feel con dent that I was able to observe

a well done procedure.

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