Executive Editor: Joseph Schatzker, Richard Buckley

Authors: Michael Castro, Richard Buckley, Andrew Sands, Christina Kabbash

Phalanges

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Glossary

Dorsal approach to P1

The veins are superficial and should be preserved, especially those which run longitudinally in the long axis of the toe. enlarge

Anatomy

The veins are superficial and should be preserved, especially those which run longitudinally in the long axis of the toe. The arteries and the nerves are basically situated on the medial and on the lateral aspects of the toe.
The best approach to the toe is therefore in the sagittal plane, in line with the dorsal axis of the toe.


Make a longitudinal incision over the center of the toe from the MTP joint up to the PIP joint. enlarge

Skin incision

Make a longitudinal incision over the center of the toe from the MTP joint up to the PIP joint.


Division of the extensor tendon enlarge

Division of the extensor tendon

Avoid cutting the longitudinally running veins. Expose the extensor tendon and incise it in a Z-shape fashion making a short transverse cut proximally and distally and then by cutting the extensor tendon itself in the midline.


Retract the cut tendon and expose the capsule. enlarge

Capsulotomy

Retract the cut tendon and expose the capsule. Then with scissors dissect out the sides of the joint capsule and insert small right angle retractors to protect the neurovascular structures on each side of the capsule.
Make a cut ¾ of the perimeter of the capsule. Do not cut the volar plate.


Close the wound with a running 4-0 self-absorbing suture. This enlarge

Wound closure

Close the wound with a running 4-0 self-absorbing suture. This makes suture removal unnecessary.

v2.0 2017-03-23