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Minimally invasive forefoot surgery: a cadaveric study.

Vivekanandan Dhukaram1, Anna Prasthofer Chapman, Piyush Kumar Upadhyay

  • 1Department of Trauma and Orthopaedics, University Hospitals, Coventry and Warwickshire, Coventry, UK.

Foot & Ankle International
|December 4, 2012
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Summary
This summary is machine-generated.

Minimally invasive forefoot surgery (MIS) shows minimal risk of neurovascular and tendon injury. However, achieving precise osteotomy planes requires anatomical knowledge and cadaveric training for safe clinical application.

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Area of Science:

  • Orthopedic Surgery
  • Anatomy
  • Surgical Techniques

Background:

  • Minimally invasive surgery (MIS) in the forefoot aims to reduce cosmetic impact and tissue disruption.
  • Concerns exist regarding potential iatrogenic neurovascular and tendon damage with MIS forefoot procedures.

Purpose of the Study:

  • To anatomically assess the risk of iatrogenic injury during minimally invasive forefoot surgery.
  • Evaluate potential damage to neurovascular structures and tendons in cadaveric specimens.

Main Methods:

  • Ten cadaveric feet underwent simulated MIS procedures, including lateral release, minimally invasive chevron and Akin (MICA), and distal metatarsal extra-articular osteotomy (DMO).
  • Procedures were performed by a consultant and a registrar using a mini-C-arm.
  • Post-procedure dissection identified and documented any neurovascular or tendon injuries.

Main Results:

  • No injuries to the dorsal medial cutaneous or plantar interdigital nerves were observed.
  • The arterial plexus supplying the first metatarsal head remained intact.
  • No flexor or extensor tendon damage was identified; however, osteotomies were not consistently in the desired plane.

Conclusions:

  • This cadaveric study indicates a minimal risk of neurovascular and tendon injury with MIS forefoot techniques.
  • Challenges in achieving precise osteotomy planes suggest a learning curve associated with these procedures.
  • Emphasis is placed on the need for comprehensive anatomical understanding and cadaveric training before clinical MIS application.