Dorsolateral Approach to the Flexor Sheathes of the Second to Fifth ToesThe dorsolateral approach to the second to fifth toes provides safe access to the flexor sheath and its contents. It is used mainly in the treatment of curly toes either when flexor tenotomy or flexor-to-extensor tendon transfer is used.
The neurovascular bundle lies plantar to the approach. Incisions placed too far in a plantar direction may endanger these vital structures.
Position of the Patient
Place the patient supine on the operating table (see Fig. 1-1). Good lighting and a good exsanguinating bandage and tourniquet are essential. The tourniquet may be placed on the mid-thigh. Alternatively, use a soft rubber bandage to exsanguinate the foot, then wrap the leg tightly just above the ankle. The use of a toe tourniquet is not advised, as this may interfere with the incision and tether the tendons.
 Figure 48-1 Make a 2-cm longitudinal incision on the lateral aspect of the toe running along the junction between the wrinkled dorsum and the smooth plantar skin. Center this incision over the proximal interphalangeal joint. |
Landmarks and Incisions
Palpate the proximal interphalangeal joint of the toe. Passively flexing and extending the joint should confirm its position. Note the junction between the wrinkled dorsum and the smooth plantar skin on the side of the toe. This is the key surgical landmark.
Make a 2-cm longitudinal incision on the lateral aspect of the toe running along the junction between the wrinkled dorsum and the smooth plantar skin. Center this incision over the proximal interphalangeal joint (Fig. 48-1).
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