Name: Minimally Invasive Cheilectomy
Uploaded: 2018-09-17T00:00:00Z
Channel: Arthrex
Description: Jorge I. Acevedo, MD, (Jacksonville, FL) and James McWilliam, MD, (New York, NY) demonstrate their technique for a minimally invasive cheilectomy using the Arthrex ® DrillSaw Highspeed 200™ power system. The corresponding sawbones demonstration can be found via this link: https://www.arthrex.com/link/asset/qL2_GUgf7UyJKAFk1_QVfw

<p>Jorge I. Acevedo, MD, (Jacksonville, FL) and James McWilliam, MD, (New York, NY) demonstrate their technique for a minimally invasive cheilectomy using the Arthrex<sup>®</sup> DrillSaw Highspeed 200™ power system. The corresponding sawbones demonstration can be found via this link: <a href="https://www.arthrex.com/link/asset/qL2_GUgf7UyJKAFk1_QVfw">https://www.arthrex.com/link/asset/qL2_GUgf7UyJKAFk1_QVfw</a></p>

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English  - en

video

VID1-01407-EN | B | Minimally Invasive Cheilectomy

Jorge I. Acevedo

Human

James McWilliam

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Surgical Technique Videos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Minimally Invasive Cheilectomy

So my incision is approximately two centimeters proximal to the joint. And keeping in mind trying to avoid the dorsal medial cutaneous nerve. Then I'm going to make an incision. And then we're going to spread with the mosquito. And then we'll use the elevator to elevate the tissues. Basically I'm using my contralateral hand to know how far I've gone as far as the joint is concerned. And again I'm not trying to elevate above over the spur but just right to it. Once you've elevated, you'll bury your burr. You don't want to pull up on the soft tissues with the burr. You don't want to have any chance of entangling the tissue. And so we'll try and demonstrate this. So you can sort of feel it and basically. Kind of go into the wave. And I like to look at this because you can definitely take out too much at times. And so I like to see what I'm doing. I can feel that I've left a little bit of a ridge, but we could actually floor this. And you could see I'm into the wave there, which is exactly what you want. You don't want to go over the wave, and you can basically complete that as a two lane. You can express the bone from the area of surgery just by squeezing. And that will take a lot of the bone out. Sometimes you might want to use a rasp. Now this rasp isn't to necessarily rasp bone spurs out, it's just to help facilitate removal of the already moralized bone from your operative area. The other thing you use is a syringe. This is a needle. We typically use an angiocath, but a 14 gauge angiocath one that's big enough to deliver enough fluid in to make your irrigation worthwhile. So you can sort of irrigate to express a good amount of that bone even before you use the rasp, because otherwise you're rasping forever. That is the typical colectomy. And you can see we've flattened out the the spur. If there's a significant osteophyte from the proximal phalanx, it can be removed through the same maneuver and through the same portal. So just a couple pearls to avoid soft tissue issues is you don't want to elevate the burr up onto the tissues, and you don't want to plantar flex the toe while you're doing this maneuver. Typically, I'll close these with some 400 nylon or prolene suture. Some people would prefer to just put steri strips on, but I prefer a formal wound closure. I typically use A40 prolene suture to close this incision and remove the sutures. At ten days to two weeks, patients are walking on this immediately. Weight bearing is tolerated in a postoperative shoe with a bulky dressing. I'll let them transition to a comfortable shoe after the first dressing change, which they'll perform on their own in 72 hours and maybe put a band aid over the portal. And if they're comfortable in a, in a, you know, accommodative shoe, then I'll encourage them to go into that because I want them to start weight bearing and moving as soon as possible at the latest. Patients come into the office after this at two weeks and they're put into a shoe, then they might be a little bit stiffer and I might really encourage them to do some passive range of motion exercises. But typically physical therapy is not necessary.

Minimally Invasive Cheilectomy

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