Surgeons Rethink Approach to Minimal Incision Foot and Ankle Surgery

2/20/2008

Patients reap multiple benefits, but surgeons rethinking one-size-fits-all approach

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Media contact: Melissa Matusek
(773) 693-9300, ext. 1314
melissa.matusek@acfas.org

Many patients who undergo foot and ankle surgery are recovering faster and with smaller surgical scars, thanks to new minimal incision techniques and tools. At the same time, foot and ankle surgeons are questioning whether smaller is always better, according to the American College of Foot and Ankle Surgeons (ACFAS).

"In the 70s and 80s, there was a trend towards small incisions for the sake of small incisions," says Lawrence Ford, DPM, FACFAS.  "Surgeons are now recognizing that the incision has to match the procedure and the patient."

Minimal incisions provide several potential benefits for patients, including smaller scars, faster tissue and bone healing, and fewer complications such as pain, bleeding and infections. These techniques can also reduce complications for high risk patients, such as those with circulatory problems caused by smoking, diabetes or other conditions.

The disadvantage of minimal incision procedures is loss of visual exposure, or the surgeon's ability to see the injured tissues or bones with the naked eye. The foot is a compact body part, filled with 26 bones, 30 joints, and more than 100 muscles, ligaments and tendons.

"Depending on the patient and the procedure, a wider exposure may be preferable to a small opening that is made just for the sake of a small scar," says Ford. "More surgeons are embracing an approach that matches the incision size to the individual patient and condition being treated."
 
Ford gives the example of a patient who falls off of a ladder and shatters his or her heel bone, requiring an operation. For some patients, a small incision technique may be appropriate. It would allow the surgeon, guided by miniature cameras and scopes, to insert metal plates and screws to secure the bones in the correct position without compromising the surrounding delicate soft tissues. Healthy blood flow is important for bone healing. A few, small incisions would disrupt fewer veins and arteries. But Ford points out that every patient's injury or condition is different, so in some cases a larger incision can make repairing a complicated injury easier. 
 
Small incisions can be especially beneficial for repair of Achilles tendons, which suffer from sub prime blood circulation and can develop wound complications. Jones fractures, an injury to the bone on the outside of the foot that attaches to the little toe, also benefit from small incision procedures because part of this bone receives less blood. Arthroscopic surgery for joint pain has been performed through small incisions for many years now, and is considered standard of care for certain problems.

For more information on foot and ankle conditions, and to locate a local foot and ankle surgeon, visit the ACFAS consumer Web site, FootHealthFacts.org.

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