How The Accu-Cut Guides DPMs Through Osteotomies
Citing enhanced stability, accuracy, efficiency and better outcomes, podiatrists are praising the benefits of using the Accu-Cut Osteotomy Guide System. While osteotomies for correcting first MPJ deformities have been around a long time, Robert E. Graser, DPM, says this system enables you to customize the procedure with ease and still obtain consistent results. “The tight tolerance engineered into the Accu-Cut Osteotomy Guide System allows surgeons to custom tailor their osteotomies via a simple method that is consistently stable and reproducible case to case,” explains Dr. Graser, who invented the system. The guide for specific procedures comes sterile packed with a custom blade and two 0.045 K-wires, according to Biopro, the system’s manufacturer. The company says the system features a simple mount and cut technique, which facilitates “fast and efficient performance of complex osteotomies.” It adds that “the two-point fixation of guide creates a stable platform for cutting osteotomy precisely every time.” Gerard Yu, DPM, says guide systems improve cutting accuracy and reduce the incidence of complications. “I use (the Accu-Cut) and feel anyone doing this type of surgery ought to use some type of guide to ensure the best possible cuts and therefore outcome,” explains Dr. Yu, a Fellow of the American College of Foot And Ankle Surgeons and the Director of Podiatric Medical Education at the St. Vincent Charity Hospital in Cleveland. “The device helps to decrease bone healing complications by ensuring a perfect hand and glove fit, so to speak.” Easing Concerns Over Complications Of The Chevron Procedure Biopro notes that using the Accu-Cut can address several complications in performing the common Chevron Procedure, which is indicated for pain associated with hallux valgus deformity and an inability to function in conventional shoe wear, among other indications. According to Dr. Graser, surgeons have traditionally performed Chevron osteotomies freehand or with relatively crude guide systems that lacked reproducibility and precision. However, changes in angulation, pitch or thickness of cuts often result in instability, difficulty in transportation and difficulty in obtaining or holding rigid fixation. “These factors allow excess motion within the osteotomy site that can lead to excessive edema and prolonged healing time,” explains Dr. Graser. However, the enhanced stability you get with the Accu-Cut may reduce these concerns. The company says the system has a few key features that address potential complications. These features include: • A fixed angle at 55 degrees. The company says this prevents the angle of the osteotomy from being either too small, creating intrusion into diaphyseal bone, or too large, creating an instability. • Tight tolerances between the blade and the saw guide. Biopro says this prevents any loss of bone substance by the saw and eliminates the convergence and divergence of osteotomy surfaces, prevents inadvertent PASA over-correction and reduces the likelihood of malunion associated with instability. • A longer custom blade. The company says this helps you ensure a complete through and through osteotomy. With these benefits, the company claims that the Accu-Cut can help you “create the most stable osteotomies possible” and allow you to achieve “rigid internal fixation … with near perfect apposition.” It says there is “less worry of prolonged edema and mal- or non-union” and the company claims the system facilitates quicker healing and a faster return to full function for the patient. While Mark Kravette, DPM, has only used the system three times, he believes the Accu-Cut has promise. “I think (the Accu-Cut) is a very handy device and creates very accurate cuts that reproduce and the osteotomies seem to be healing better,” notes Dr. Kravette. He says some DPMs like to create a long arm on their osteotomy devices and he is trying to find a way to do that with the Biopro device. How The Device Can Help With Surgical Modifications Dr. Yu has found the Accu-Cut to be helpful in performing modifications to a common procedure. “The device allows you to remove an extra segment of bone to shorten and/or plantarflex the capital fragment or metatarsal head for modifications of the Austin designed to assist in correcting hallux limitus deformity,” notes Dr. Yu. Dr. Graser says podiatric surgeons may also find the system’s availability of dorsal wedge guide sizes helpful in performing the Youngswick-type modification in long first metatarsal and hallux limitus cases. He says the guides allow you to remove a precise 1-mm, 2-mm or 3-mm dorsal wedge of bone before closing the osteotomy. Dr. Graser notes the overall procedure is the same except you would perform a second dorsal-proximal cut prior to transposing the osteotomy. “These wedges are uniform in thickness across the entire width of the osteotomy, something virtually unattainable with traditional free-hand cutting,” explains Dr. Graser. “Thus the surgeon can tailor the amount of correction needed based on multiple factors such as metatarsal length, amount of first metatarsal primus elevatus and intermetatarsal angulation.” Other Key Considerations Indeed, the variety of available guides along with the system’s variable hinge axis allow you to correct in all three cardinal planes, according to Biopro. Dr. Graser says the standard guide is also excellent for performing Reverse Chevron (mini-Austin MA) procedures to correct Taylor’s bunion. The versatility of the Accu-Cut Osteotomy Guide System allows for multiplane and multidirectional correction with high patient satisfaction and minimal complications, according to the company. Drs. Graser and Yu also cite the convenience of the Accu-Cut, noting that it comes completely packaged and sterilized. Since all the components are disposable, Dr. Graser adds the system “facilitates quick clean up and turnover between cases.” Price may be one drawback to the device. Dr. Yu feels the price of Accu-Cut, which Biopro lists as $63 each or $315 for a box of five, may be a “barrier to regular use by outpatient surgery centers” and other institutions. In The Future Dr. Graser says several two-stage Accu-Cut Osteotomy Guide Systems will be available in the near future. These systems will enable you not only to correct intermetatarsal angle and elevatus but will also facilitate correction of proximal articular set angle in 5-degree, 10-degree and 15-degree increments, according to Dr. Graser. He points out that a Chevron-type closing base wedge osteotomy guide system is also under development. Dr. Graser says this device allows you to correct intermetatarsal angles in 10-degree, 15-degree and 20-degree increments while allowing easier and more stable screw fixation versus traditional closing wedge procedures.