. : Mr de , can you forward yourselves?

: Readily, I work in Spain in the town of , Méditerranéenne city, near to Valence, in the north of Andalusia. I exert exclusively into private at the hospital . I work with
a associate who is called and who makes . We are the people responsible for the department of traumatology which is consisted a team of ten people. My line of business relates to primarily the pathology of the foot.

 

. : How were you trained?

: I made the studies of at the University of then a specialization of traumatology and csotcina.comedy in the service of the Instructor with the of Madrid. Then, I went to Italy during one year to the Institute of Bologna to supplement my formation. In addition, I also went to the United States and in other hospitals.

 

. : And you, Christophe de ?

: I made my studies of in Paris, with Western Paris Faculty, and then I made my boarding school in Western area in Poitiers. Then I left afterwards as senior registrar for two years in the service the Instructor , who is now the service
of the Instructor in Bordeaux. Afterwards, I made one year of in Paris at the hospital Robert in the Instructor in infantile csotcina.comedy. I am now with the private clinic with a completely deprived activity, but in an establishment which makes a point of functioning on the university mode with a team which is invested much in the prospective surgery, in the surgery with a future, and for that of which we will speak in the surgery about the foot and of ankle.

 

. : How did your installation in the private one occur?

: That was a very natural passage in the measurement or the team of which sought a new associate, turned towards the service from which came already two team members i.e. Doctor and . I was taken with the test during a few months and we decided to continue this path together.

 

. : Which are your centers of interest in surgery?

: In our hospital, one makes surgery of the sport, and percutaneous surgery of the feet. The others associated deal especially with traumatology.

 

. : Why this interest for the foot?

: We followed progress of the surgery, i.e. we started after 1980 to carry out the surgery, then naturally invasive mini surgery. We were interested there about 1993. Gradually, the request of the patients related to the foot with 70% and thus I was brought to me to occupy some more and more.

: The service of Pr where I was senior registrar is always interested in the foot. Two surgeons of the private clinic of , Doctor and myself, like Olivier , hospital, let us animate a group of search under the patronage of Pr .

When I arrived in the private clinic of , my guideline was done more towards the surgery of the lower extremity in particular in the sportsman. The invasive mini surgery of the foot was added to the surgery that I realized already on the level of the foot. It oldest is associated private clinic, Michel very closely dependant with the Spanish csotcina.comedic medium which sensitized us on what did without the other side of the Pyrenees. I thus left to meet in de , which received me in an extraordinary way. It is there that I discovered this invasive mini surgery, then I left with him to the USA to learn the rudiments with the Academy from them from New-Orleans, into 99 with Dr. . From there, we began our activity from invasive mini surgery of the foot in Bordeaux where we organize run for
2nd time with Dr. and Dr. de .

 

. : And where this surgery began?

: In Europe, it did not exist. We started with us to interest in it with the same state of mind as that which had led us to develop the . We first of all sought some bibliographical references. The first emanate from an American podiatrist in 1945, which begin with small interventions from elimination from the exostosis. It seems that he had very good performances.

 

. : What is it that a podiatrist?

: That has nothing to do with our French . They are students who make
4 years of medicine in common with Medical , then they tilt towards a sub-speciality for two years additional. They are thus not Doctor which comes to take part here in the exchange rate here is titular him of the two diplomas. It thus has the diploma of Podiatrist, which is called , and the diploma of Medical . Therefore it is important in our eyes to have it like interlocutor.

 

. : Was the development of this invasive mini surgery braked because it was practiced only by podiatrists?

: It began at the podiatrists since 1945 but the poor level of their scientific publications had to represent a heavy handicap. The bibliography was quasi non-existent before work of into 1985 which developed the specific operative procedures concerning the hallux valgus, the metatarsalgias, and the deformations of the little toe

 

. : It was thus the first to make this surgery credible on the scientific level. This is you who introduced this surgery in Europe thereafter?

: Yes, and we checked feasibility with an excellent anatomist, Doctor of the University of Barcelona, with which we practiced these interventions on corpse. Then, we made dissections to check with open sky the negotiable instruments of the percutaneous gestures. We noted anatomical good performances with respect of soft-tissues; I am convinced that our work made it possible to define the exact reference marks of the channels initially. It is the basis of the results of all our studies, of the communications in all the congresses and of the book published two months ago when are described all the indications, all the techniques and all the anatomical elements of various pathologies.

 

. : What are you able to make today in invasive mini surgery?

: We can carry out the majority of the interventions of the before-foot; hallux valgus, hallux rigidus, processing of pathologies of the , neuroma of , disease of Freiberg, metatarsalgias, deformations of the little toe. With the level of the back foot, we can discuss the syndrome of the plantar , the pathology of insertion of the Achilles' tendon, the disease of . These techniques are exposed in a book which I recently published at , “ #07645A and #FFFFFF LED”, but which is currently available only in Spanish.

 

. : Which are the most frequent indications?

: The pathologies most usually operated by the percutaneous method are the hallux valgus, the surgery of the pallet , the surgery of the toes out of hammer. The metatarsalgias are discussed by percutaneous osteotomy with the level of the necks, and the feature is less long than in . In the event of of the II , the section relates to the II and III metatarsal; the of the III is discussed by section of II, III, IV metatarsals, that of the IV per section of the III and IV . The bandage as in all the percutaneous surgery of the foot is capital. All the departments are solidarized with the first, not to increase the angle m2. The main counter-indications are represented by the antecedents of infection, any preliminary surgery, and the presence of luxation of the MTP. In the continuations, radiographies show one cal osseous bulky making fear a delay of consolidation; it of it is nothing, and all is standardized in a few months. The surgery of the fingers out of hammer contains several times which are more or less associated according to the indication. The possible gestures are the following: section of the bungee cord and dorsal capsulotomy of the MTP, section of flexor and osteotomy of consequently channel initially, osteotomy of , where necessary of . Of course the totality of these gestures is carried out by percutaneous channel, under fluoroscopic control. The bandage is there too capital; it makes it possible to lower the first phalanges, to extend the IP, and to fold back the toes operated towards the first department.

 

. : Mr de you have the same indications?

: de has enormous experience which enables him to enlarge its indications to the maximum. In what relates to us, in partnership with the Talus group of the , we determined at the beginning of more limited indications. It seems that the standard indication of hallux valgus which we can carry out into percutaneous, is the surgery of first intention with an angle m2 lower or equal to 16°, the MTP congruent with a correct joint mobility. Thus I believe that the invasive mini surgery of the foot can bring much. After when the experiment develops, one can enlarge the indications. The invasive mini surgery of the foot can relate to the adjacent departments in particular the osteotomies of the necks of the metatarsal which one can compare, although it is extra articular, with a type of former . The surgery of the claws of toe, the pathology of the 5th department in particular are also accessible to our techniques. As regards the back foot, one appreciated the experiment much on the surgery of the breakages and the plantar . carries it out by percutaneous milling, our team rather in an extra-articular endoscopic way.

 

. : One is astonished by the blind side by the gesture and the absence by osteosynthesis. What is it complications, in particular of the attack of the soft parties and pseudarthrosis?

: For the realization of the percutaneous surgery, it is absolutely necessary to have a radiological control during the intervention. For that we use the fluoroscopy, method very similar to the image intensifier which with the advantage of irradiating between 3 and 10 times less. We take many precautions for the points initially and the operational strategy. For example, the with the strawberry is done nothing but after have carefully taken off the capsule of the exostose, in order to create a room of risk-free milling. Thus the percutaneous surgery is not another method, but it is a different technique to achieve the same goals. Thus proceeding, the soft joint surfaces and parties are not injured during the intervention. Concerning the absence of osteosynthesis, does not generate more secondary displacement or of nonunion that the conventional surgery, on the condition of placing by post-operative a silicone block enters the first and second toe, and to supervise the patients well. Under these conditions the complications (between 3 and 5%) are not higher than those generated by osteosynthesis itself.

: I believe that it is very important to say that it is a surgery which can be superimposed on the training of the surgery. It is gestural to learn and one should not that the surgeon arranges while borrowing here or there an engine, the strawberry of the colleague ENT etc… the whole after simple reading of an item. It is a surgery which is learned, it is necessary to go in an exchange rate, to work on corpse, to see the surgeons who carry out this type of surgery. For the moment, she is not taught within the university, therefore we are delight to be able to take part in an exchange rate with Dr. de to teach it. If one carries it out by adhering to the , one has very little postoperative risk.

 

. : Because of the absence of osteosynthesis, do you have specific criteria of selection of the patients?

: We have the same selection criteria of the patients. The post-operative observance necessary for the invasive mini surgery is the same one as for the conventional surgery. In addition we can enlarge recruitment towards the patients at risk like the diabetics. It is an exceptional method in the processing of the plantar ulcers without the risks of the surgery with open sky which can lead to the amputation. We can carry out percutaneous dorsal osteotomies with very good performances and observe the fast closing of the ulcer. For that against indications must be the same ones.

 

. : Do not think not that there is some danger to promote this technique?

: The danger is to have patients who seek more than what we can offer to them and in particular the pure esthetic requests. Concerning the csotcina.comedists, the percutaneous surgery is very tempting. It is fast, in the congresses one can show pretty diagrams, beautiful video, good performances and everyone would like to make some. Everyone thinks that it is a technique that one can very quickly realize and the invasive mini surgery is very with the mode. But the aforementioned is not easy because it poses problems of geometrical guideline and requires precise anatomical knowledge. For that we imperatively recommend to follow exchange rates and to initially carry out the techniques on corpse in order to avoid the poor performances. Once one acquired the control of the surgical gesture, the results are good.

 

M. O. : Is the technical and ancillary medical environment that this surgery requires a brake?

: Not, I think that the hardware which is used for this technique is a hardware whose csotcina.comedic surgeons have the practice relatively. They are mini strawberries with mini engines which are already used largely in the spine surgery in particular. The amplifiers of brightness can render service at the beginning of the experiment with the place of the fluoroscope. Into postoperative, it is necessary to know to very attentively supervise the hold of the osteotomies by the bandages. The patients must be seen at completely given periods with controls radios to ensure a good development of osteosynthesis. It is true that we have the services of one chiropodist with the private clinic, and that is very convenient for the construction of the interdigital silicone orthotic devices.

 

. : When these exchange rates did start, and which attend them?

: These exchange rates started in the United States since many years, and in Spain with in 1995. They began in France in October 2002. We are with the second session and once again it is very important to be able to take part in it and to complete practical works on corpse. Usually take part during the csotcina.comedic surgeons and in particular those which have already experience as regards foot. They heard of a percutaneous technique: we try to involve them with a very practical training. We are represented by the Group of Search in Invasive Mini Surgery of Ankle and Foot in Bordeaux, which works with the Talus group. It soon will accommodate in its bosom of the surgeons
from Marseilles, of Lyon, of Toulouse, and is ready to accommodate others of them. I hope that it will develop more and more, but while trying to keep a scientific side so that the dissemination of the technique is done in a correct way, that she is not mislaid in dangerous deviations for the patients.

 

. : Where is your work published?

: We forwarded the technique to the French company of Medicine and
of Surgery of the Foot and today we distribute our technique and our first results by the Talus group. We hope to carry out quickly in the long term multicenter studies and to publish them in the medical press.