Generally, posterior tibial nerve block anesthesia or epidural anesthesia can be used in hallux valgus plastic surgery. There are two plastic methods for hallux valgus.
A, hallux valgus synovial sac, osteophyte resection
This kind of hallux valgus plastic surgery is mainly suitable for patients with pain caused by mild hallux valgus complicated with recurrent bunion, or patients with toe movement affected by proliferative osteophyte.
The operation steps are as follows:
1. Incision: Make an arc incision on the dorsomedial side of the metatarsophalangeal joint of the big toe, and open the flap downwards to expose the thick synovial sac. Use scissors to cut the whole bursa along the wall of bursa. If the adhesion between the capsule wall and the skin is heavy, it is not necessary to peel it off reluctantly, and the capsule wall can be left here to avoid peeling the skin. Then, in the hallux valgus plastic surgery, a V-shaped incision was made on the inside of the joint capsule, and the joint capsule flap was opened to the distal end, exposing the inward protruding metatarsal bone and hyperplastic osteophyte.
2. Excise the osteophyte and cut off the adductor pollicis tendon: use the osteotome to excise the osteophyte from the proximal side to the distal side, and excise the lateral part of the metatarsal bone that is not in contact with the phalanges. Flatten the bone crest. In hallux valgus plastic surgery, the adductor tendon of thumb (including transverse head and oblique head) was cut off, and the proximal end was sutured and fixed with the joint capsule outside the metatarsal bone.
3. External fixation of suture incision: after correcting the deformity, stop bleeding completely, move the big toe inward, hallux valgus plastic, reset the cut joint capsule flap and do overlapping suture. After sewing layer by layer, put a wooden splint on the inside of the big toe, and then bind it and fix it. After hallux valgus plastic surgery, pay attention to raising the affected limb and remove the stitches in 7 ~ 9 days.
Second, partial amputation of the proximal phalanx of the big toe (Keller operation)
Steps of hallux valgus plastic surgery:
1. incision: hallux valgus plastic surgery was performed on the dorsal side of the proximal phalanx of the big toe, with a length of about 5.
After exposing the proximal phalanx, the periosteum was cut vertically, and the periosteum on the surface of the phalanx and the joint capsule and ligament attached to the base of the phalanx were stripped by hallux valgus plastic surgery.
2. Osteotomy: clamp the base of phalanx with pliers, pull it out of the incision, cut it horizontally at the junction of its proximal end 1/3 with a small board saw, and then grind the edge of the bone end with a bone file. After removing part of the phalanges in hallux valgus plastic surgery, a wider gap can appear between the phalanges and metatarsals. If there is synovial sac and hyperplastic osteophyte on the medial side of metatarsal bone, it should be removed at the same time.