The sentinel vein in hallux valgus surgery

NewsBot · Oct 3, 2011

Members do not see these Ads. Sign Up.
The sentinel vein
An anatomical guide to localisation of the dorsomedial cutaneous nerve in hallux surgery
N. Makwana, et al
Journal of Bone and Joint Surgery - British Volume, Vol 93-B, Issue 10, 1373-1376.

Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery of the hallux. The resultant morbidity can be disabling. In the light of the senior author’s operative observation of a sentinel vein, we undertook a cadaver study to investigate the anatomical relationships of the dorsomedial branch of the medial dorsal cutaneous nerve. This established that in 14 of 16 cadaver great toes exposed via a modified medial incision, there is an easily identified vein which runs transversely superficial and proximal to the nerve. In a prospective clinical study of 171 operations on the great toe using this approach, we confirmed this anatomical relationship in 142 procedures (83%), with no complaint of numbness or pain in the scar at follow-up. We attribute this to careful identification of the ‘sentinel’ vein and the subjacent sensory nerve, which had been successfully protected from damage. We recommend this technique when operating on the great toe.
Click to expand...

NewsBot · Jun 3, 2017

Location and direction of the nutrient artery to the first metatarsal at risk in osteotomy for hallux valgus
Ichiro Tonogai, Keizo Wada, Kosaku Higashino, Yoshihiro Fukui, Koichi Sairyo
Foot and Ankle Surgery; Article in Press

Highlights
•Osteotomy for hallux valgus interrupts intraosseous blood supply to the first metatarsal, presumably causing non-union, delayed union, or osteonecrosis of the head of the first metatarsal. We investigated the first metatarsal nutrient artery, arising from the first dorsal metatarsal artery, and identified aspects of surgical technique contributing to nutrient artery injury.
•Enhanced computed tomography scans of 8 feet of 8 fresh cadavers were assessed. Barium was injected through the external iliac artery; location and direction of the first metatarsal nutrient artery was recorded.
•Mostly, the nutrient artery entered the first metatarsal at the distal third or junction of the middle and distal thirds obliquely from a proximal direction coronally; entry point and direction varied axially. Saw blade overpenetration alone or with extensive capsular stripping might damage the artery.
•Location and direction of the first metatarsal nutrient artery was established.
Click to expand...

Background
Osteotomy for hallux valgus interrupts intraosseous blood supply to the first metatarsal, presumably causing non-union,delayed union, or osteonecrosis of the head of the first metatarsal. We investigated the first metatarsal nutrient artery, arising from the first dorsal metatarsal artery, and identified aspects of surgical technique contributing to nutrient artery injury.

Methods
Enhanced computed tomography scans of 8 feet of 8 fresh cadavers were assessed. Barium was injected through the external iliac artery;location and direction of the first metatarsal nutrient artery was recorded.

Results
Mostly, the nutrient artery entered the first metatarsal at the distal third or junction of the middle and distal thirds obliquely from a proximal direction coronally; entry point and direction varied axially.Saw blade overpenetration alone or with extensive capsular stripping might damage the artery.

Conclusion
Location and direction of the first metatarsal nutrient artery was established.
Click to expand...

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Vein patterns variation in the feet

The Lower Limb Perforator Veins

The Role of Iliofemoral Vein Compression in Diabetic Foot Ulceration

How common is deep vein thrombosis in patients attending the diabetic foot clinic?

Experienced podiatrist looking for Saturday or eveing work in Brisbane

Patient takes podiatric physician to court over deep vein thrombosis

Treatment of foot varicose veins

Share This Page