CLUBFOOT ACHILLES TENOTOMY TECHNIQUE
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CLUBFOOT ACHILLES TENOTOMY TECHNIQUE Using The Single-Use, Sterile Packed Clubfoot Achilles Tenotomy (CAT) Kit

CLUBFOOT ACHILLES TENOTOMY More than 100,000 babies are born around the world each year with clubfoot – one of the most prevalent congenital deformities to date, with approximately 80% of cases seen in developing countries.1 Serial manipulation and casting come closest to achieving effective treatment, so that the child’s feet will be functional and pain-free with full mobility.1 About 90% of children who undergo Ponseti method treatment for clubfoot still have an abnormally tight Achilles tendon after the casting process is complete.2 A pediatric orthopedic surgeon can correct the problem...

CLUBFOOT Achilles TENOTOMY (CAT) KIT KIT COMPONENTS Scalpel Handle Dissector Mini Blade #6400 Mini Blade #6700 17” x 24” OR Towel (x4) 1% Lidocaine, 5ml 3cc Syringe Leur Lock 25-Gauge Needle 4.5” Scissors 3.5” Mosquito Clamp 5” Needle Holder 4” x 4” Gauze (x6) Chloraprep, 3ml (x2) Adhesive Bandage (x2) Neosporin Ointment, 0.9cc Exam Gloves (Med & Lg) CAT Convenience Kits: Sterile Packed, Ready to Go Your team works to help as many patients as possible. Convenience kits save valuable time inand outside of the clinic (or operating room) so you can do just that. Designed to streamline an...

SURGICAL TECHNIQUE Note: Prior to the tenotomy, order the brace and schedule a brace fitting. The foot must be in a dorsiflexed and abducted position to fit into brace. Patient Positioning An Achilles tenotomy may be done by the clinician in the clinic or operating room setting. Two people are required – one to hold the foot and another to perform the tenotomy. The patient is positioned by gripping the child’s calves, with his or her knee in extension. Sterilize Generously apply antiseptic circumferentially to the foot, ankle, and lower leg (fig 1). fig. 1 Prepare and Apply Drapes to...

SURGICAL TECHNIQUE (CONT.) Injection Pre-Tenotomy Palpate the tight Achilles tendon while dorsiflexing the foot to identify its location (fig 3). Inject 1/10cc of local anesthetic medial to the Achilles tendon, approximately 1cm proximal to its insertion (fig 4). Note: If too much anesthetic is used, it may be difficult to feel the tendon. Skin Incision Define the Achilles Tendon Borders Make a tiny puncture using the selected knife blade on the Scalpel Handle Dissector anteromedial to the Achilles tendon, 1cm proximal to its insertion (fig 5). Next, reverse the Scalpel Handle Dissector and...

SURGICAL TECHNIQUE (CONT.) Cutting the Tendon Re-insert the Scalpel Handle Dissector utilizing the blade end, once again, just anterior to the Achilles tendon in the previously identified space created in Step 6 (fig 7). Turn the scalpel perpendicular to the tendon and dorsiflex the foot (fig 8) while applying pressure on the blade to create the tenotomy. Be careful not to button-hole through the skin (fig 9). The “release” obtained after a complete tenotomy is characterized by a palpable “pop.” The result will be 10-20 degrees of additional dorsiflexion. Use Scalpel Handle Dissector to...

SURGICAL TECHNIQUE (CONT.) Perform a standard closure (fig 12) and cover with Neosporin ointment and an adhesive bandage (fig 14). Apply the cast with the feet in maximum dorsiflexion and external rotation (fig 15). WISHBONE MEDICAL CLUBFOOT ACHILLES TENOTOMY SURGICAL TECHNIQUE

ORDER INFORMATION Clubfoot Achilles Tenotomy (CAT) Kit ITEM DESCRIPTION Scalpel Handle Dissector 3cc Syringe Leur Lock Curved Strabismus Scissors, 4.5” Curved Mosquito Clamp, 3.5” Medium Exam Gloves (Nitrile PF) Large Exam Gloves (Nitrile PF) REFERENCES 1. Pulak S, Swamy M. Treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting and its critical evaluation. Ethiop J Health Sci. 2012; 22(2):77–84. 2. 2. Bor, Noam et al. “Sedation protocols for Ponseti clubfoot Achilles tenotomy.” Journal of children’s orthopaedics vol. 1,6 (2007): 333-5....

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