I had a unique opportunity this morning to perform a bunionectomy on two different patients. What was unique was that both of these patients had previously undergone correction of their bunion on their other foot. So both were back for a second go 'round to take care of the other foot. It's an honor when I can earn the opportunity to perform a patient's second surgery.
One of the things that's important in a second case is that you duplicate the success of the first case. Bunion surgery is somewhat of a step-wise procedure; you do this step first and then the next. But each case is always a little bit different from the previous case. I sometimes marvel at the variables and the fact that the outcomes are so similar despite the variables.
In both of these cases I found the second surgery seemed more challenging than the first. The anatomy is the same but it's all the little things like alignment of the toe and positioning of the fixation. Unbeknownst to the patient, I do ask a lot of questions pre-op in an attempt to duplicate the success of the first surgery. For instance, "Did you have sutures to remove or did they dissolve or did they dissolve on their own?" or "what kind of pain medicine seemed to work for you?" The more I can duplicate the first procedure, the better the overall success of the second procedure.
Invariably there is going to be some differences with the outcome, and that's where I use some of the products we carry on www.myfootshop.com. My three go-to items are the bunion regulator and the large, firm toe separator. Both are used to optimize the position of the great toe once the bandages come off. I'll also use a forefoot compression sleeve to compress the surgery site. The sooner you can eliminate the post-op swelling, the sooner you'll be back in a shoe.
Although things went well in surgery this morning, it's always great to have these bunion products to fine tune the final result.
Jeffrey A. Oster, DPM