BUNIONECTOMY
A bunionectomy is a surgical procedure performed to correct a bunion, which is a bony bump that forms at the base of the big toe joint. Bunions can cause pain, inflammation, and difficulty walking, and they may also lead to other foot problems if left untreated. A bunionectomy aims to alleviate these symptoms by removing the bunion and realigning the affected toe.
There are several different types of bunionectomy procedures, and the choice of procedure depends on the severity of the bunion and the patient's individual needs. Some common types of bunionectomy include:
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Osteotomy: In this procedure, the surgeon makes a cut in the bone near the big toe joint to realign it. The bone may be held in place with screws, pins, or plates.
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Exostectomy: This procedure involves removing the bony bump (exostosis) without correcting the underlying bone deformity. It is usually performed in conjunction with other procedures to realign the toe.
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Lapidus procedure: In this technique, the surgeon fuses the joint at the base of the big toe to correct instability in the foot that may contribute to the bunion.
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Distal soft tissue realignment: This procedure involves adjusting the soft tissues around the big toe joint to help realign the toe.
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Resection arthroplasty: This is a more aggressive procedure, in which the surgeon removes a portion of the joint to alleviate pain and deformity. This is typically reserved for severe cases or elderly patients with limited mobility.
The recovery period for a bunionectomy varies depending on the type of surgery performed and individual factors. It generally involves a period of rest, elevation, and immobilization of the foot, followed by gradual reintroduction of weight-bearing activities and physical therapy. Full recovery can take several weeks to months, depending on the specific procedure and individual healing process.
Anesthetic Implications for Bunionectomy
Anesthesia type: General anesthesia, regional anesthesia (spinal, epidural, or peripheral nerve block), or monitored anesthesia care with local anesthesia
Airway: ETT or LMA
Preoperative:
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Determine the most suitable anesthesia technique
Intraoperative:
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A compression tourniquet may be used
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The tourniquet should be released after 2 hours to prevent injury
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Supine position with arms out
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Duration: 30 to 60 minutes
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EBL minimal
Postoperative:
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Pain management
Complications:
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Foot deformity
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Chronic pain
Sources:
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).