Practical Keys To Improving Fluency In Foot And Ankle Surgery

By Luke D. Cicchinelli, DPM, FACFAS

Learning and performing effective surgery is akin to studying and speaking a foreign language. Not every one does so with the same fluency. The patient often does not speak a single word. Anatomy is the vocabulary, surgical procedure selection is the syntax and some aspects like verb conjugation and internal fixation sequences simply have to be committed to memory.
   There are levels of competence or dominion in both language and surgery. The most basic is phraseology. The second level of competency is conversational. Finally, there is complete fluency that includes the ability to lecture in the language at any time, be fully understood by all audiences and use nuances and idioms of the native speakers’ tongue effortlessly.
   Surgical fluency follows a similar course from theoretical coursework in medical school to residency program practical training to the continual learning and refinement of private practice.
   Accordingly, the following are shared lessons, experiences and exercises with the hope that they help colleagues communicate more effectively and speak the language of surgery more fluently.
   Lesson one: Do not forget your sharp surgical nail procedures. Chemical matrixectomies work great and some doctors have not done a surgical nail in 15 years. However, a certain number of patients with various medical complications, diminished circulatory status or suspect soft tissue integrity will do better with a sharp surgical nail procedure and heal in seven to 10 days.
   Practical experience: All it takes is one or two phenols that continue to drain for eight to 10 weeks to convert you to the occasional surgical matrixectomy such as Frost, Winograd or Zadik. Patients keep requesting antibiotics and consulting doctors start saying they “cannot exclude osteomyelitis” and order Tc-99 bone scans. In reality, it is simply a slow to heal phenol and nothing more. When performing surgical nail procedures, be absolutely certain there is no dense white matrix tissue left on the undersurface of the medial and lateral nail folds. If you are not looking at subcutaneous tissue, you have left matrix and will have a regrowth of a least a spicule.
   Translation to patient: We are surgically removing your nail root. Your nail may grow crooked if we only fix one edge. We can accept that possibility or fix both edges. It is your choice.


Great article.
I sense the very same thing going on, possibly to an even greater extent (Think the Tower of Bable) in biomechanics.
Do you agree?

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