Minimally Invasive Forefoot Surgery: A Cadaveric Study

Abstract

Background: Minimally invasive surgery (MIS) aims to improve cosmesis and minimize soft tissue disruption by using small skin incisions. When using MIS in the forefoot, there is concern about iatrogenic neurovascular and tendon damage. The aim of this anatomical study was to assess the risk of iatrogenic injury while performing MIS techniques. Methods: Ten normal cadaveric feet were used. All of the procedures were performed in a cadaveric lab using a mini-C-arm by two surgeons: a consultant who has attended a cadaveric MIS training course but does not perform MIS in his regular practice (eight feet) and a registrar (resident) who was supervised by the same consultant (two feet). In each foot, the surgeon performed a lateral release, a minimally invasive chevron and Akin (MICA) procedure for the correction of hallux valgus, and a minimally invasive distal metatarsal extra-articular osteotomy (DMO). Each foot was then dissected to identify any neurovascular or tendon injury and photographed. Results: The dorsal medial cutaneous and the plantar interdigital nerves were intact in all specimens. There was no apparent damage to the arterial plexus supplying the first metatarsal head. No flexor or extensor tendon injuries were identified. On examination of the osteotomies, the cuts were found not to be in the desired plane. In both MICA and DMO, the dissection also revealed some intact soft tissue at the osteotomy site, which may preserve vascularity and add stability to the osteotomy. Conclusions: Although there has been concern regarding neurovascular and tendon injury, the findings were consistent with minimal risk, which is consistent with reports in the literature. This study also reflects the challenges associated with performing the osteotomy in the No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Single incision lateral release for hallux valgus using a cervical biopsy blade: A cadaveric study

“…The procedure was conducted on fourteen fresh frozen cadaveric below knee specimens. This is comparable to the previous literature using a cadaveric model in which 10 to 30 specimens were used [7,12,17,18]. Of the fourteen specimens four clinically exhibited hallux valgus deformity.…”

Increasing the safety of minimally invasive hallux surgery—An anatomical study introducing the clock method

“…One of the feared risks of MIS is iatrogenic 17 damage to neurovascular and tendinous structures. One cadaveric 18 study has deemed MIS forefoot surgery safe and has reported minimal risk, which is consistent with clinical studies in the literature, although no anatomical references were provided [5]. Q4 MIS for hallux valgus was described amongst the first techniques in the development of this discipline.…”

Third-Generation Percutaneous Forefoot Surgery

“…Clinical series and comparative studies have been published [47][48][49][50]. Additionally, cadaveric results [51,52], technique reports [53], and radiological validations [54,55] have been described. Despite the fact that for some authors percutaneous surgery of the forefoot lacks scientific support [56][57][58], recently two systematic reviews published support its indication in hallux valgus surgery [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59].…”