General Information for Adult Surgery

The following information is to give you an overview of the principles of operative foot surgery under my care.  It cannot be exhaustive and is intended as a guide to inform you of what you may expect when having surgery.  Listed on this website are more specific details for numerous procedures and the information contained  on those pages should be read in conjunction with the contents of this page.

Preoperatively

  • You will be seen in a pre-assessment clinic or undergo a telephone interview within a few weeks prior to surgery. A members of the nursing team who will go through your medical history and arrange tests where appropriate eg blood tests, heart trace (ECG), chest X-ray (CXR)
  • You will be admitted on the day of surgery and seen by a nurse from the ward.  Mr Uglow will see you and mark your leg and ask you to sign a consent form.  The consultant anaesthetist will also see you and check that you are fit for your operation
  • Sometimes medical problems are identified at the pre-assessment visit or by the anaesthetist before the operation.  On occasion it may be necessary to postpone your operation in order to further investigate or treat a problem.  Rest assured that this only happens when the risks to yourself from having an anaesthetic are considered to be increased
  • Patients may be fit in the preassessment clinic but develop a cold prior to admission.  Coughs and colds can pose a significant risk if an anaesthetic is given and so your operation may need to be postponed. You are advised to phone for advice and you may still be asked to come in on the day of the operation for a final decision.  Please be reassured that if your operation is postponed then this is for your benefit

Operation

  • You will be escorted from the ward to the operating theatre by a nurse.  If you are able to walk then this is the preferred method of transfer.  If unable you will be taken in a chair or on a trolley
  • When arriving at the theatre suite you will be checked in first and then taken to the anaesthetic room.  Here you will have various monitors attached to you and you will usually be given some oxygen to breathe from a mask.  A small plastic cannula will be placed in your arm.  You will be anaesthetised according to the method discussed with you by the anaesthetist beforehand
  • After the operation you will be taken to the recovery room and monitored until it is safe for you to transfer back to the ward.  You may or may not remeber being in the recovery area
  • During surgery on your leg a tourniquet will be applied to stop the flow of blood to your leg.  This ensures a clear operative field. If  a joint is to be opened or entered or the procedure involves operating on any bone then antibiotics will be given as a propylaxis against infection

Complications

  • Complications can occur during any type of surgery.  Infection occurs in less than 1% of planned orthopaedic operations.  If this occurs to you, it may involve the skin in which case there may be an increase in pain and a delay in wound healing.  Antibiotics will need to be given but it would be very unusual to need any further surgery
  • Infection can rarely affect the deep tissues and bones.  If this occurs then antibiotics will be needed and further surgery to clean out the infected area may be performed.  The risks of infection are increased in patients suffering from diabetes, concurrent infection or any form of immunocompromisation
  • Bleeding can occur into the tissues or joint after an operation.  During the operation blood vessels are identified and sealed off with an electric current (diathermy) or tied with a suture.  Occasionally they may bleed afterwards and form a haematoma.  Mostly if this happens no action is required and the blood will reabsorb over a few weeks.  If the tissues are tense or the joint deemed to be very tight then the haematoma may need to be evacuated which would mean returning to the operating theatre.  If this were to occur it would happen within 48 hrs of the operation
  • Nerve injuries can occur.  There are many small nerve which supply sensation to the skin and these can be cut or stretched at the operation.  Large nerves are identified where possible and protected.  Sometimes the nerves fail to work properly after being handled and this can lead to numbness or tingling in the skin.  The majority of times that this happpens the symptoms will be temporary but permanent changes can sometimes occur.  It would be very unusual for persistent pain to occur following nerve trauma but it can happen
  • Thrombosis is a condition of blood clots forming in the deep veins of the leg.  If this happens then pain may be felt in the calf and there may be more swelling in the foot than expected.  If this condition develops it is an urgent problem and will need an ultrasound scan of the leg to confirm the diagnosis and if positive treatment will be needed to thin the blood.  This involves heparin immediately and then warfarin within a few days.  The latter would be needed for between 3 and 6 months depending on circumstances.
  • The ways to minimise the risk of thrombosis are to ensure adequate drinking volumes after the operation, early movement of your toes, foot and ankle (depending on the presence of plaster) and early walking.  You will be seen by a physiotherapist after your operation who will actively help you mobilise but it is important to keep performing any exercises which are shown to you.

Postoperatively

  • Depending on the operation to be performed your foot will be dressed using gauze and a wool and crepe bandage or a plaster of paris cast.  If the latter you will have been advised of this prior to surgery.  Only rarely would a plaster need to be used when not anticipated preoperatively.
  • You are advised to move your toes and foot and ankle joints as early as possible after surgery.  Specific details for different operations will be given to you by the physiotherapy team.
  • Mr Uglow will see you on the morning after surgery to ensure that all is well and advise on any specific management details.  An outpatient appointment will be made by Mrs Carol Barstow which will be either in the first or second postoperative week depending on the operation performed
  • If any problems occur before this first visit then you should phone the Spire Southampton Hospital and ask for ward 2 (direct dial: 023 8076 4371) or Carol Barstow (direct dial: 023 8076 4304).  Problems may include dressings becoming loose or slipping, bleeding from wounds, increasing pain or generally feeling unwell including developing a temperature

This information is intended to give you an outline of what to expect when having an operation.  If you have any questions then please ask so that we may deal with any issues that you may have.