|
|
|
Search
09/29/2015 Don Peacock, DPM
Standard of Care for Bunion Hardware (Burton Katzen, DPM)
I am a proponent of MIS surgery and I feel the debate on fixation is off topic when discussing the advantages of MIS foot surgery. I have performed the Katzen modified MIS Wilson and was personally taught this surgery by Dr Burton Katzen. His technique is incredible and the results are great in the appropriate patient.
That being said, some patients require fixation and some do not. The decision to use fixation lies mostly in what your goals for the foot correction are. For example, some foot types require plantarflexion of the 1st ray and this is better achieved by utilizing fixation.
The real power of MIS is incorporating the philosophy into your traditional arsenal. An example of this would be a diabetic patient with a chronic ulceration under the 1st met. Typically, I would treat this by tendon rebalancing ( gastro recession and Per. Long. lengthening). Soft tissue rebalancing is usually less invasive than bone work despite needing larger incisions. Remember there is a difference between minimally invasive and percutaneous procedures. I have a philosophy that uses MIS despite incision length.
I call this the MEP philosophy (minimalistic effective procedure (s)) and its a hybrid approach. If this same patent had a foot type displaying a high pronatory end range motion (PERM or plantar flexed 1st met) I would do the GR and a percutaneous non fixated DFWO of the 1st with the desire for the 1st ray to dorsiflex.
if I needed to address a 2nd met ulcer with a high SERM (hype-rmobile 1st) I may do a GR and a plantarflexory MIS 1st met osteotomy with fixation.
Fixation depends on your goal at hand and the foot type you are working with. At the risk of sounding flip, we do not need a fixation debate with bunion correction. We have too many options for bunions already and the difference between a well executed traditional procedure with fixation and a properly performed MIS technique is not really important and the head to head comparison is mute.
As a proud professor in the AAFAS I can honestly tell you that great power lies in MIS techniques when addressing a multitude of deformities other than hammertoes and bunions etc. As a point of reference, the power of MIS in transverse dominant plane deformities and DM forefoot salvage is hard to imagine unless you have done it. It can be life-saving.
I want the best trained traditional foot surgeons to come and be a part of the MIS discovery and to join us at our seminars. I hope that by teaching well trained surgeons these techniques they can add some of these procedures to their already accomplished skill set. In doing so we can improve lives and make advancements by learning from these talented traditionally oriented folks as well. You know who you are. I could easily list you.
Don Peacock, DPM, Whiteville, NC
There are no more messages in this thread.
|
|
|
|