Clinical Tip: Postoperative Dressing for Hallux Valgus ...

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Postoperative dressing after surgery for correction of hallux valgus deformity is of utmost importance in maintaining acceptable correction of the toe until there is ...
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Clinical Tip: Postoperative Dressing for Hallux Valgus Surgery Nikiforos P. Saragas, F.C.S.(SA) Ortho, M.MED. (Ortho Surg) (WITS) Johannesburg, South Africa

of losing position or putting the medial structures under any early stress.

INTRODUCTION

Postoperative dressing after surgery for correction of hallux valgus deformity is of utmost importance in maintaining acceptable correction of the toe until there is sufficient soft-tissue healing. The accepted method is initial compression for the first 12 to 48 hours followed by weekly gauze-and-tape toe spica dressings, maintaining the alignment of the toe in an anatomical position for 6 to 7 more weeks.1,2 This technique (although effective) is time consuming and technically demanding. Appropriate material may not be readily available or cost effective and often is uncomfortable to the patient. The advantages of the described method are as follows:

This dressing technique does not treat pronation of the hallux. Significant pronation, therefore, will have to be treated intraoperatively with appropriate soft-tissue balancing or an Akin osteotomy. Care should be taken when surgery is performed on the second toe at the same time. If a Kirschner wire is used to stabilize the toe, the sponge will not cause any lateral deviation of the second toe. If, however, no Kirschner wire is used, the sponge should be avoided, because there is a risk of displacing the second toe. I have used this Reston (3M, St. Paul, MN) foam dressing in over 550 patients who had hallux valgus corrections (including chevron, basal dome, and scarf osteotomies, with or without the Akin procedure) in the past 10 years, with good results.

1) The foam is versatile (i.e., it can be used in varying thicknesses, depending on the surgeon’s decision as to whether he prefers the toe to remain in neutral, varus, or valgus). 2) Trimming can be done at any stage during the followup period. 3) Adequate immediate postoperative bandage compression keeps the great toe comfortable as it is pushed against a sponge, without compromising the position by pushing the toe into valgus, so there is no need for early change of dressing. 4) The product is readily available and cost effective. 5) The firm spica-type strapping for a prolonged period is unnecessary. 6) Being self-adhesive, the foam remains in place when the dressing is removed for wound or skin inspection or bandage change without the danger

TECHNIQUE

A square of thick Reston foam is used (Figure 1) as a spacer in the first webspace, applied immediately after skin closure (Figure 2). Adequate pieces of the foam are

Corresponding Author Nikiforos P. Saragas, F.C.S.(SA)Ortho, M.MED. (Ortho Surg) (WITS) Linksfield Park Clinic and University of the Witwatersrand, Orthopaedic Surgery P.O. Box 1153 Highlands North Johannesburg, Gauteng 2037 South Africa E-mail: [email protected] For information on prices and availability of reprints, call 410-494-4994 X226

Fig. 1: Sterile thick Reston (3M, St. Paul, MN) foam.

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Foot & Ankle International/Vol. 26, No. 10/October 2005

Fig. 2: Foam applied immediately after skin closure.

precut and sterilized separately to avoid the same large sheet of foam being sterilized repeatedly. One side of the Reston foam is sticky, which allows it to adhere to the great toe. The foam must be firmly supported (Figure 3). This foam remains (not necessarily the original) for a period of 6 to 8 weeks, depending on the progress as assessed on a weekly (or 2-week) basis.

Fig. 3: Foam firmly supported.

REFERENCES 1. Coughlin, MJ; Mann, RA (eds.): Surgery of the foot and Ankle, St Louis, Mosby, 1999. 2. Kitaoka, HB (ed.): Master techniques in orthopaedic surgery: The foot and ankle, Philadelphia, Lippincott Williams & Williams, 2002.

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