PREPRINT

  • 1. Introduction and Surgical Approach
  • 2. Incision
  • 3. Dissect Tissue off Metatarsal Head
  • 4. Continue Dissection to Amputate Toe
  • 5. Continue Dissection to Create Skin Flaps Along Periosteum
  • 6. Remove Metatarsal Head
  • 7. Closure
cover-image
jkl keys enabled

Left First Toe Amputation (Ray, Cadaver)

Samuel Schwartz, MD; Laura Boitano, MD
Massachusetts General Hospital

Transcription

CHAPTER 1

So we're starting now with a left first toe Ray amputation- starting with draping. Yeah. So we start off by marking the incision, just to include the proximal phalanx and essentially to be able to remove the first metatarsal head. So we're marking circular, the base of the toe, and then we're going to make a incision along the lateral- sorry, medial aspect of the foot to include the first metatarsal head.

CHAPTER 2

Start down here? Yeah. Pretty dried out, huh? Yeah.

CHAPTER 3

So now we're essentially taking the tissue off the metatarsal head. All right. So here, we'd see some avascular tendon, which we'll eventually remove. Here's the metatarsal head, and here's the toe, essentially being completely amputated.

CHAPTER 4

Okay, so there's the toe amputation.

CHAPTER 5

Now we'd have to use with sharp dissection, and clear off part of this metatarsal head to be able to get down to cortex. Maybe increase that little racket, you know. Yeah. So we're creating essentially skin flaps along the periosteum. We use a- we could also use a periosteal elevator at this stage. We have to come up a little bit higher actually, just to be able to get where it starts to thin out, you know. So typically this stage would be a little bit more straightforward, but she's got a pretty enlarged metatarsal head, so we were getting up a little higher on the, on the actual metatarsal bone to be able to transect it cleanly. What do you think? I think that's doable. It may take more than one cut, but I think that's doable. Yeah, I think so too.

CHAPTER 6

Yeah, yeah, I think that's good. Okay. Do you have curved Mayo scissors? Yeah. So as anticipated, the bone just sort of fractured into a thousand pieces. Okay. Sort of cutting into the bone. There we go. Okay. I'm just going to take out some of this, you know? Yeah. So at this stage we would take- we would clear the joint capsule. See if I could get this last little piece of bone right here. See how this- yeah, see if you can get the bone cutter back. There's one little hanging fragment right there, you see that? Yeah. Good. So now we essentially just remove all this avascular tissue, as best we can. And then we're left with this space that we would then close. Yeah. Like that. Do you want to just do some interrupteds? Yeah. What do you think, just to approximate that? Yeah, I think that's okay.

CHAPTER 7

Yeah, so I think, just do just straight up interrupteds, you know? Yeah, I think so. Thanks Latz. Let's do one more here. Sounds perfect, I think it will be... Call it a day, yeah.