Bobby Ndu, MD, will discuss new technique that is revolutionizing foot and ankle reconstructive surgery. These surgeries used to require large formal incisions and with these new techniques we are able to reduce incisions down to the size of a keyhole. Dr. Ndu discusses these new techniques and the positive impact they will have for patients; this can mean smaller incisions, less soft tissue dissection, less scarring, less pain and swelling, and a faster return to activities.
In this segment of his presentation he discusses bunions.
Bobby Ndu’s, MD Physician Profile There's a new technique that's revolutionizing foot and ankle reconstructive surgery today. I'm going to show you how we're using it to help our patients here at penn medicine. Hi I'm dr bobby undo an orthopedic surgeon at penn medicine. And I want to share with you some of the new and exciting advancements in minimally invasive foot and ankle surgery. These techniques have allowed us to take procedures that used to require large formal incisions and their subsequent dissections down to being done using incisions the size of a keyhole. Using a smaller incision means that there is significantly less soft tissue dissection which means less scarring, less pain and swelling and often a faster recovery with an easier return to activity for our patients. But like any kind of surgery, minimally invasive surgical techniques still carry risks such as bleeding infection or damage to adjacent anatomy. To name a few. Let's take a look at one of the procedures You may have heard about a minimally invasive bunion correction. So we first begin by making a small incision on the side of the toe and that's about the extent of the incision that we need to start our procedure after we make this incision that's about the size of the blade. We then take our cutting instrument which is a low speed, high torque burr and verify our position on X ray. We're very particular about the angle at which we make that cut to make sure we get the most optimum correction. We use the burr to make our cut through the bone which allows us to start the process now of correcting the bunion. We then proceed to shift the bone over into its new position and that is highlighted here by our instrument that is passed down the canal of the first metatarsal and represents a block to the metatarsal head, pushing it laterally, creating our correction after we have verified that we're happy with our shift and position. We placed two K wires into position through a separate keyhole incision to help hold the head and its new place. And then we verify on our X ray that we're happy with the position of the bone and the wires before we commit to anything. After we place the initial guide wire we place a second one parallel to it, just to give us additional fixation and to ensure that what we're trying to create is a stable construct. We then measure to determine the length of screw that we will need to pass over the wires to leave in as our permanent implant. We proceed to over drill the wires to make room for the screws and this is all being done through the second keyhole incision, we can appreciate our instruments still holding our metatarsal head shifted and our temporary fixation of our guide wires coming here from the base of the metatarsal. Once we verified that we've drilled to the appropriate depth, we then placed our screws over the wires to give us our permanent fixation and now we can see that we have placed our screws over the guide wire and you can appreciate that the head of this screw is quite specially shaped to match the metatarsal shaft and ensure it will not cause any soft tissue irritation given the trajectory that is required for us to connect the metatarsal shaft to the head in its newly realigned position. And we can see here the relatively small nature of the two incisions that we've had to use now to accomplish this one that can be visualized right here where our screws entered and the second incision up here where we made the original cut to the bone that allowed us to correct the bunion. Now, if we were to do this as a classic open chevron nasty autumn E, the incision would have to be much broader, requiring significantly greater dissection to allow us exposure of the bone to make the appropriate cuts. We need to come through the skin, the underlying muscle as well as the capsule that surrounds the joint to give us access to the bone before we can even begin to make our cuts. And here you can see me moving the tissues aside still before we would have even started the procedure. One of the beautiful things about minimally invasive surgery is we have avoided all of this and we've been able to do the same procedure through a keyhole incision that is significantly smaller than what you see in front of you here now. So now let's look at the difference of that open incision versus what we did earlier with the minimally invasive. You can see here the increased risk, time and effort that's required for an open approach as opposed to the simple elegance of the small incision of an M. I. S. Approach. And that is why we're moving the majority of our patients to a minimally invasive approach because of what it means for them and their recovery. My colleagues and I here at Penn Medicine are constantly working to provide the latest surgical techniques to help our patients get back on their feet, to contact us about surgical options for your patient or to refer your patient to pen orthopedics, Call our dedicated referral line or visit Penn medicine dot org slash refer.