Articles, Blog

Partial Toe Amputation

November 15, 2019


mouth top incision where we start here
and we’re gonna run it around to here and do another one like an ellipse, okay?
That way we’ll have plenty of skin to pull it together. Do you feel any of that?
Okay. You’re okay with watching? Alright, my dear. Here we go. You let me know, my dear, if you feel anything, okay? So that was the skin incision, and
now we grab it and we’re going to deepen it and remove the subcutaneous tissue.
We’re gonna remove this whole entire flap of tissue. So, this young lady has already lost the
distal phalanx of her toe, and so we’re gonna remove the middle phalanx. She has
a wound on the bottom of her toe, and her toe is very rigid, so the decision was made to do a partial amputation versus any other hammer toe procedure just for
healing purposes. She’s very active, she walks four to five miles a day, and
she wants to continue that lifestyle as quickly as possible. So, because she’s not
concerned about cosmetic reasons she just wants to get rid of the ulcer and
go back to normal we chose to do an amputation. In office, even cooler. Then she doesn’t have to have any anesthesia which is definitely easier
for the patient, and as long as the patient’s brave. Some people can’t do
this. How long will she have to be non-weight-bearing? Or does she have to be off work? She won’t have to be non-weight-bearing. At all. We’re gonna stitch it up. She has a
post-op shoe that offloads the forefoot, so we’re gonna let her continue
in that with a surgical dressing on and just keep it clean under. This is much like real surgery where you have to lay on each other. obviously there’s lots and lots of soft tissue that’s holding the bone in there, otherwise it would wiggle on a day-to-day basis so it is very difficult
to find all of that and get rid of it. There may be some arthritis in this area and that can kind of make joint isolation a
little bit more difficult, but it’s okay because we can definitely get through it.
But sometimes you just have to find the joint line and it might not be as wide
as it was when she was 20. Totally normal. Even in the OR when you do a
joint isolation, sometimes I do take my bone cutter and I have to get through
that arthritic area, so we may have to do a little bit of that. Just
goes to show you that x-rays don’t show you the whole joint. This is exactly what you
want to do, so you have this plantar flap of skin and then you’re gonna have your
dorsal flap of skin, and once the bone is removed it’s a nice, easy, fish-mouth
incision to put them back together with plenty of space so that it’s not tight
and it’s an easy place to heal. when You kind of hug the bone so you keep as much fat and vasculature in the skin as possible. That
way the skin doesn’t die, and it heals really well. We’re gonna need saline. I thought we wouldn’t need it. Obviously, this isn’t the preferred method, we would love it to just fall off. So what does arthritis look like if it’s in the joint? Nothing. Like you used to have a joint, and now you don’t. And that’s what we saw on X-ray, that’s why a Flexor Tenotomy wouldn’t work, because that joint was so rigid already. There it is. Look
at how beautiful. impressed that Elise is in the room. Just a little bit more to take off. So I didn’t catch that on tape earlier, but, you mentioned that you have since been able to come off of your CPAP machine, And how did that happen? You took that problem in your own hands. So we have it all off there, I just want to make sure. This is to get rid of any little bone
fragments from where we had to chomp it. Instead of it coming out in one
individualized piece, of course we have little bone fragments that could have
gotten stuck places. In the OR you use a bulb syringe. It gives
it more pressure. Dr. Carter used to pressure with her
finger. Beautiful. We’re gonna suture this in a
simple suture fashion. It’s going to give it room to dream. If we let all
of that blood kind of stay in there it’ll cause a clot. You cut it about a centimeter. You want to leave the tails longer that way when you try to take them out you can find them.
Sometimes they’ll bury themselves down in the skin. We’re gonna go back and
forth from one side of the incision to the other, that way we get a good even
stitch and a better cosmetic result for her – even though she’s not really
worried about it we don’t want it to look terrible.
So you mentioned you’ve been walking a whole lot, what’s your plan for the
winter time? Do you walk outside? Do you do inside? I work at a mall. It opens at 9:00 in
the morning. and you’re in a safe
environment there’s a groove and there’s several different groups that meet in
the food court and they were a lifesaver for me this winter when I just needed
somebody every day and I would just go walk and then sit and listen and they’re
very caring I haven’t seen them for couple months because it’s been summer,
but that was very life-saving for me to get out of the house every day. You know what, I know that our followers are going to love to hear
that because they are so many of them in similar situations as yourself, and you
just taught me something today. So I love that. Especially coming up on Diabetic Awareness Month. She also was losing
her husband, and had spent so much time taking care of him as many women do, that
after he passed she decided she had to fix herself so she would stay around. So
she decided to change her whole entire life at that point. She did amazing. You
may have had quite the journey this past year. I’m sure you are looking forward to
seeing that group again this winter it’s looking good the County Extension office
here in Huntington also had a couch potato challenge this year and they gave
us a list of about the walking trails in Lexington and challenged us to get out
walked and a friend of mine a friend of mine and I
we’re the only two that competed the entire challenge
yummy mmm sound call so um they actually cancel the event villain it went from I
think April to July and even though I had surgery in May I still took the time
to heal and then I’d finished the challenge so she and I were the only men
Wow finished it good for you it is so
impressive yeah so she has been the most dedicated person ever. One of her
concerns with having any kind of surgery is the amount of time she had to be off
her feet, and couldn’t continue to walk. So, for a lot of people walking is
therapeutic, mentally and physically. And they need to stay doing that they need to keep in their rhythm, and so hopefully this is going to help her to continue to
be active, and continue to lose weight and maintain her new health. Now I have to ask, when you walk do you just let your mind go? Do you listen to music? Do you listen to podcasts? Everybody’s got a podcast now. I do listen to music, I do listen to podcasts. My current favorite has been Gretchen Rubens Happiness Project is a
four tendencies Thank You Garson Elodie tendencies there’s but I have one’s
artistic effect that really interested in habits I’ve always been interested in
habits and so this year I have kind of focused on several bit I felt like I
needed to do last one honey You made it. Good job, honey. Her post-op dressing I’m pretty simple. I
just do a sailing soak gauze like two She’ll leave it for five to seven days before she comes back.
We’re going to put her on an antibiotic because her toe is a little bit infected,
it was red and warm, so we’re going to fix that.

8 Comments

  • Reply you build it we destroy it February 7, 2019 at 7:24 pm

    What a great video. Sorry that someone lost a toe end because of diabetes, this was nice to see on YouTube. Nice work doctor

  • Reply David Carter February 18, 2019 at 8:57 pm

    Watching this as I just had a similar procedure.

  • Reply Erin Norwood March 13, 2019 at 9:22 pm

    Who is helping with your surgery?

  • Reply Kayla Franklin March 28, 2019 at 8:56 pm

    I usually have a strong stomach, but this was too much for me!

  • Reply Takara Gay May 7, 2019 at 2:09 am

    Looked like a perfectly good toe to me

  • Reply NC redbird May 9, 2019 at 3:36 pm

    Wow not only was this patient kind enough to allow her treatment and surgery to be shared but she is also brave and tough as nails!! I'm a nurse and have seen it all but I couldn't do this myself! Totally impressed with this patient. Pray she gets total relief from the surgery and back to her full life soon.

  • Reply Kharius August 9, 2019 at 10:48 am

    thats what i call quality content.

  • Reply S Horn September 14, 2019 at 1:36 am

    I am going through this procedure on Monday, same toe…

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