SLR - November 2015 - Nadia Shah
Reference: Botezatu I, Marinescu R, Laptoiu D. Minimally Invasive-percutaneous Surgery – Recent Developments of the Foot Surgery Techniques. J Med Life. 2015;8 Special Issue: 87-93.Scientific Literature Review
Reviewed By: Nadia Shah, DPM
Residency Program: Hoboken University Medical Center
Podiatric Relevance: This article is relevant to a foot and ankle surgeon because it discusses current minimally invasive, percutaneous procedures for the forefoot. Traditionally, minimally invasive forefoot surgeries have had a bad reputation. Poor patient selection may lead to peri-operative pain, surgical imperfections, scars and risk of recurrence. Samuel Brouk first proposed metatarsophalangeal osteotomies in the1990s, which became the most common procedures for correcting hallux valgus deformities. Mariano de Prado popularized percutaneous techniques for foot osteotomies, which allowed for a decrease in post-operative morbidity, recovery and rehabilitation times.
Methods: Minimally invasive surgery requires specific equipment for all percutaneous techniques. One must be comfortable using mini-blades, beaver handles, rasps and high power rotatory burrs. Osteotomies are held in place by a solid dressing instead of fixation material since space is limited in percutaneous procedures; therefore, post-operative dressing is essential because it keeps corrections in place.
Results: After reviewing literature, it is important not to perform surgery for cosmetic reasons. Surgery should be performed if a patient has pain or is unable to wear shoes with comfort. There are advantages with percutaneous forefoot procedures, such as lower risk of stiffness, lower risk of nonunion, lower risk or deep infection. However, disadvantages with improper technique include thermal injury to skin, delayed or malunion, neurovascular damages, lack of visibility and aggressive use of tools. Vernois conducted a three-year study on 341 patients which reported satisfaction and radiologic results. Ninety-five percent reported good results, seven required additional surgery and all osteotomies healed at three months. Kadakia documented percutaneous osteotomies to have an unacceptably high risk of complications, specifically osteonecrosis, nonunion, malunion and recurrence. Results with performing percutaneous forefoot surgery are experience dependent and based on the knowledge of anatomy and knowledge of open forefoot procedures.
Conclusions: In conclusion, there is not enough literature to fruitfully determine the outcome of percutaneous forefoot procedures. The author makes a strong point. The advantages of percutaneous procedures are great, however, the disadvantages are also significant and may be even worse than those associated with an open procedure. A surgeon must know his or her anatomy and open procedures well before venturing into minimally invasive procedures.