Above is presented before and after photos of a patient who underwent pan flexor and extensor tenotomies of all the lesser digits.

 

Comments and critiques are welcome.

I think isolated extensor tenotomies present an excellent treatment option in patients with distal digital ulcerations, especially in those patients who's medical comorbidities preclude more aggressive intervention.

 

Thanks for the reply Ryan.

 

 

Do you mean isolated flexor tenotomies like described below?

 

It seems the minimal incision , or ambulatory surgery, guys were right about some things.

Would you mind describing your exact techniques in detail (where are the incisions placed etc) for us and the residents who read this forum?

Many thanks!

I have performed percutaneous flexor tenotomies (as described in the reference below)  using the sharp beveled edge of an 18gauge needle. The needle is inserted centrally into the flexion crease at the desired tenotomy level using a sweeping motion to perform the flexor tenotomy. The capsular tissue may be similarly transected to release any additional contracture. The digital deformity should be flexible or semi-rigid at the IPJ level with no contracture or a reducible deformity at the MPJ level. This procedure (in my hands) is most amenable to either distal digital hyperkeratotic or ulcerative lesions secondary to a mallet toe deformity. Additionally, the procedure is useful for patients with multiple medical comorbidities.  This procedure is followed by digital splinting.

Best regards,

Chris Taylor, DPM

2008 Podiatry Institute Update Chapter 1, Pp: 1-3. Flexor Tenotomy: A Simplified Technique (Mickey Stapp, DPM, Craig Camasta, DPM).