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. Ndu, MD, 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 calcaneal osteotomy.
@PennMDForum 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 call. Canio asked ya to me while minimally invasive techniques can be used for standalone procedures. They can also be used as an augment to much larger hind foot reconstructions. Such as we're going to see here in this situation, we're going to be doing an Osti autumn e of the cal cane ius or a cut in the heel bone. We first begin by inserting guide wires into the heel bone to create borders or to give us an outline of the cut we would like to create and we can see here the outline of those borders that we're trying to create and that's formed by this pin coming up and this other pin coming down creating the triangle or wedge that we plan to remove. Once we've established that we determine our starting point by trying to come close to the inferior apex of that triangle where we will make our keyhole incision. As you can see visualized here to be about the size of my blade, we then enter with our cutting burr, which is a high torque, low speed burr designed to protect our soft tissues, but is strong enough to allow us to cut the bone. We first entered the bone and then we start a process of reaming away everything that was between our two wires in that triangle. And as we ream we remove the burr every once in a while and place suction through the same hole to remove any bony fragments. This allows us to keep track of what we're doing while ensuring that we're doing it safely and respecting the patient's adjacent soft tissues. So here we can see the wedge that we have created. And the bone that we have removed represented by the clear space that you can see here right in front of the wire. And we will continue to make that larger and larger as needed until we have it large enough that we can now begin to mobilize our Osti autumn e site and close down that wedge so that you can see where it is now shortened and much smaller as we are now able to move this poster tuba ross et anterior early. Thus changing the entire angle of the cal cane ius. After we've shifted it forward, we then place guide wires to help hold the position. We then place screws across our Osti autumn E site to bring it together and close down the gap we have created. Thus changing how the patient's foot meets the ground, how their achilles meets the foot and how the patient perceives their discomfort going forward with significant improvement of pain. This is our entry site for all of the hardware that we placed to adjust our call cranial angle. And we can appreciate here the actual size of this incision being approximately one centimeter, which also matches the size of our surgical site measuring approximately one centimeter pictured here on the side of the foot. So we have just realigned the entire Cal Kane ius as well as this patient's ability for ambulance station through these two small one centimeter incisions. Now, let's compare that to what the open incision looks like for the minimally invasive we've taken it and shrunk it to one centim were on the open approach. You can appreciate that. It is at least 4-5 cm and requires me to move aside a significantly greater amount of tissue to get down onto the bone before we would even start making our cuts to remove a wedge and attempt to bring it forward. The need for increased visualization requires increased surgical time and dissection. One of the other differences between minimally invasive and open surgery is the requirement to hold the tissues open. The constant need to apply tension to the tissues to improve visualization also decreases the blood supply to those tissues during the approach and during the surgical procedure, which increases the chances of infection, wound healing, complication or postoperative wound breakdown due to poor blood supply. So here we can see the true difference between our minimally invasive incision versus our formal open incision and the amount of dissection that is required and the amount of soft tissue mobilization that is required. And that's why we're moving most of what we do here to our minimally invasive approach is to help our patients recover faster, more comfortably and get back to life more quickly. 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.