MINIMALLY INVASIVE SURGERY 

MINIMALLY INVASIVE  FOOT & ANKLE SURGERY

NEW SURGICAL TECHNIQUES PRODUCE LESS TRAUMA

Trauma is a bad thing, isn’t it? That’s common knowledge, even to those who know nothing about medicine. Psychological trauma can lead to a whole host of problems. For example, most have heard of post-traumatic stress disorder. If a person is scared enough to have psychological disorders, they have been “traumatized”. When someone suffers a physical injury, there is trauma to some structure, be it bone, soft tissue or skin.

Clearly, trauma is a bad thing. The body reacts to trauma in various ways, with inflammation being a general term for the body’s primary response to physical injury. This is a natural process which can lead to healing of damaged tissues or aid in the defense against bacteria and invading organisms. But inflammation can also last too long and various problems, and pain, can result. Modern medicine has developed a great variety of ways to reduce the amount of inflammation, and to minimize the length of time the process continues.

So, what is inflammation? When inflammation occurs, chemicals from the body’s white blood cells are released into the blood or affected tissues to protect your body from foreign substances. This release of chemicals increases the blood flow to the area of injury, and usually results in redness and warmth. Other effects of inflammation can include swelling, pain, stiffness, and a loss of joint function.

Who hasn’t used ibuprofen at some point? This is the most common of a large group of medications called non-steroidal anti-inflammatory drugs (NSAID’s), and, as stated, their benefits are the result of their actions on the process of inflammation. Cortisone is another example of a medication in widespread use, largely because of its effects on this natural bodily process. Various devices have been invented to reduce the consequences of inflammation, like therapeutic ultrasound, electric stimulation, hydrotherapy, and many others. Clearly, medicine recognizes that, although it’s normal, inflammation can be a bad thing.

Some forms of trauma are planned and intentional. Why would one intentionally allow themselves to be subjected to the pain and limitations of inflammation? To achieve some specific goal, some task, inside the body. It’s called surgery, a component of modern medical care that is essential to maintaining health and well-being. From removing an abnormal mass, to excision of a diseased appendix, to straightening a bent toe, surgical techniques have come a long way from the days before aseptic technique, and the use of a shot of whiskey as the anesthetic of choice.

One of the latest developments is the performance of various surgical procedures through extremely small incisions. The term most commonly assigned to this concept is minimally invasive surgery (MIS). The idea is to cause as little trauma to the tissues between the exterior of the body and the target tissue, whatever it may be, while achieving the goal of the surgery. With traditional “open” surgery, all those structures are cut to expose the target. This typically produces a significant amount of trauma, and we now know where that leads you: inflammation. But what if the goal of the procedure, whatever it may be, could be achieved while greatly reducing the amount of damage caused to the tissues found between the surgeon and the area of pathology.

Many new technological developments have allowed MIS, from specialized, tiny cameras placed at the end of long tubes, to fluoroscopic imaging. The former device allows the surgeon to see inside a joint, so that they might visualize all manner of problem. This type of procedure is called arthroscopy, and, as is typical of minimally invasive surgical procedures, entails greatly reduced recovery time, along with less pain, less chance of infection, and many other benefits.

The latter device produces real-time x-ray images, like a movie camera that shows only bone and metal, thus allowing the surgeon to visualize every move they make with their equipment, be it a knife, saw or drill. One example of the use of these principles is in the correction of a hammertoe deformity, in which the toe is bent abnormally. Sometimes the tip of the toe will contact the ground, or the knuckle of the toe will rub on the shoe with every step. Various other complications can develop because of this deformity; this list is far from complete. Most surgeons make a long incision to get to the structures that must be altered. But what if the needed changes could be made without the long opening? Predictably, this would mean less swelling afterward, as well as reduced pain, and, in general, a faster return to activity. The differences are numerous, and almost entirely advantageous.

Another example of the benefits of this type of approach for surgical correction of deformity is in the correction of a bunion. In this condition, the big toe gradually angles over towards the smaller toes, while a bony bump grows on the inside of the foot near the base of the big toe. This can be an acutely painful problem, but it can also be truly challenging when it comes to shoe fit. Simply getting a larger size is a common way to compensate, but this invariably leads to other problems. Surgical correction is the only way to normalize foot structure, but it tends to be a painful process when performed with traditional “open” methods of surgery, while minimally invasive methods can provide excellent correction, without the trauma, inflammation, pain, and risk of infection.

Minimally invasive techniques are, for the most part, more difficult to perform, due to the lack of direct visualization. Training and experience in open, traditional surgical techniques is important so that the surgeon gets that critical experience in how things look. An ability to see things three dimensionally is also invaluable. But the results of minimally invasive surgery are rewarding to both the patient and the physician, sufficient explanation as to why more and more surgical procedures are being performed with this technique. If you have some condition or problem which requires surgery, and it can be performed with these techniques, it would seem logical to choose this option. The recovery from the surgical procedure can be dramatically different, and the damage caused should be, in a word, minimal!

BUNION SURGERY - BUNIONECTOMY  

DECREASING BUNION SURGERY PAIN

Medicine was in the dark ages prior to the discovery of local anesthesia. Being able to prevent pain, in some particular part of the body, has allowed us to do so much. If you were to think about what is possible because of local anesthetics, you would realize how much this has advanced medicine, and specifically surgical procedures.

Some examples readily come to mind, with dentistry being one of the most predictable. These days, most surgical procedures performed on the extremities rely on local anesthetics.

Some form of sedation is often used to make a surgical procedure more “relaxing”, but the primary component is the administration of some form of local anesthesia, which numbs the area, preventing pain from being experienced.

A common example is the bunionectomy, a surgery performed to correct this very common foot deformity. Corrective surgery for bunions has been done for over a century, since the late 1800’s, in fact. Over a 100 different procedures have been utilized to correct this deformity, technically termed hallux valgus, although most of these procedures are historical, and no longer attempted.

A great variety of techniques and methods of correction of this condition are still currently used. For example, someone who has developed severe arthritis, one of the more common consequences of a bunion, will require a very different procedure than someone who simply has pain from the bump. Obviously, determining the nature of the sufferer’s complaints is essential.

In the case of the aforementioned individual, where there is insufficient cartilage to provide pain-free motion, one of the more common recommended solutions is to fuse the joint, which, when done correctly, provides excellent relief of pain, and a stable base of support for gait and normal Some bunion deformities are so severe that the base of the metatarsal may have to be fused to the bone in the middle of the foot. Due to the pressures of weight bearing and standing, this type of work requires very different restrictions post-operatively than simply knocking off the bump, which is another one of the many techniques used to correct a bunion.

When the base of the metatarsal bone is cut, some method of stabilizing the “fracture” that was created is essential to ensure proper healing, with stability a necessity for bone union. The bone cut can be stabilized in a great variety of ways, everything from a cast, to the insertion of metal rods to stabilize the bones, to a metal plate placed over the area, then screwed down to both portions of the bone.

Do these techniques sound painful? There is no pain during the procedure, because of the ability of local anesthetics to stop this noxious sensation. But what about after the surgery, when the patient has gone home, and is on their own? Many options exist to reduce post-operative pain, which can be extensive, depending on the individual and the procedures performed.

Much of the post-operative pain experienced is directly related to the amount of soft tissue trauma that is caused. Make no mistake about it: surgery is trauma, with the cutting of all those nerves, blood vessels, and various other structures. This causes most of the pain after surgery, not the bone This is why minimally invasive surgical techniques, in which the work is done through tiny incisions, have become so popular.

This is the basic concept behind arthroscopy, where a joint is invaded, not by a long incision, but several significantly smaller ones, thereby causing noticeably less injury, and thus, less pain. Surgical correction of the aforementioned bunion can be performed with these principles, with the work done through tiny incisions.

Various forms of fixation, such as screws or pins, are inserted to maintain the bone in the new and corrected position, but this is all done through these less traumatic small incisions. Decreased trauma One might wonder about the surgeon’s inability to see what they are doing to the bones, since these structures are not visible with this technique. Certainly, an intimate familiarity with, and knowledge of, the anatomy of the area is essential, and an absolute requirement. But the concepts utilized in minimally invasive surgery became much more appropriate when fluoroscopy, which is real-time x-ray imaging, is used.

This device gives the surgeon x-ray vision, just like a super hero, so that the bones, the bone cuts, and the altered position of the construction, can be easily visualized during the surgery. The message here is that modern surgical techniques have come a long way, and severe post-operative pain is no longer the rule.

Although people experience pain very differently, various procedures can be performed these days using these concepts, bunion correction included, thus causing greatly reduced discomfort after the operation. This is clearly demonstrated by the reduced use of post-operative pain relievers after this kind of work is done.

So if you have some deformity or medical problem which may best be treated with surgical intervention, don’t assume it will be a painful, difficult recovery. Local anesthesia and small incision surgical methods have changed the whole process.

Don’t let fear of pain guide your medical care!