Most complex surgery

[postbacpremed87]

What is the most complex surgery a podiatric surgeon can do? The surgery where all of the residents would fight over the chance to participate in it?

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[dyk343]

Any fractures involving the tibia/fibula, talus, calcaneus are always popular. I've seen an OATs procedure, Tibial plafond fx, focal dome/ supramalleolar osteotomy of the tibia, surgical correction of severe charcot foot, soleal sling decompression, etc this past week alone. It's very cool to see podiatrists operate on the soft tissue and osseous structures in the lower leg.

Sounds like a good clerkship.

 

[air bud]

Sounds like a good clerkship.

What he said

Hey, not all of us are as cool as Anklebreaker and get to go to programs like these..... But these clerkships and residencies and surgeries do exist.

However, never forget the bread and butter and what pays the bills

 

[PADPM]

Pilon fractures are one of the greatest challenges in my opinion. Since this is an injury I rarely see (these patients don't simply walk into your office) due to the triage system at our local hospitals, if I do happen to see one I refer it out to someone with more experience. You can't be proficient in such a complex surgery if not performing them on a relatively regular basis.

 

[Robert De Niro]

Which program is it?

 

[UVAallday]

whose the director if you don't mind me asking... if you do mind.. at least say what state your talking about

 

[PADPM]

Who's, who is, but not whose.

 

[air bud]

I will venture a guess that the most complex surgery is any surgery on the non compliant patient.

 

[UVAallday]

Who's, who is, but not whose.

sorry to confuse you.. thanks for the english lesson

 

[zdlamkin8195]

Just curious: For podiatrist, how long does the average procedure take? How long does one of the longer procedures take?

 

[jivecrudley]

What is the most complex surgery a podiatric surgeon can do? The surgery where all of the residents would fight over the chance to participate in it?

Why?

Traditionally podiatrists are not employed by hospitals, do not spend long days laboring over a surgical case, and the complexity of any surgery is contingent upon the necessity. The situation is boss, and the most complex cases involve multiple trauma, often involving the bone, muscle, tendons, and nerve, finally the most complex surgery is the severed limb, which if conditions permit, is reattached. Although many podiatry trainees are led to believe that some day they will be engaged in performing multiple complex surgeries, the reality is that they will not. Podiatrists will, as they traditionally have been will be treating bunions, hammertoes, and other forefoot surgeries to earn a living. These patients do not "fall from trees" as they are elective procedures, and the patient base must be nurtured, developed, and grown. The misconception many podiatrists have is that when a patient suffering multiple trauma has a foot or ankle injury the podiatrist on staff will be called is not as likely as the general trauma surgeon, or someone from orthopedics. Why? Because in multiple trauma cases there are several concurrent injuries the patient may suffer, and the podiatrist is not equipped, or licensed to evaluate, or treat. In real life practice podiatrists will find a set of procedures they are comfortable doing, often hallux valgus, arthroplasties, neuromas, and a few others and perform them throughout their career. They will hone their skills to these procedures to such extent that patients will be comfortable when the question: "How many of these have you done lately?" This question is mostly asked by patients routinely in real life.

If someone performs one, two, or three complex surgeries this would not qualify them as an expert. Doing a complex procedure every now and then does not an expert make. Unless the practitioner is familiar with tissue handling, via a general surgery, and/or orthopedic surgery residency it is unlikely they will have the training to manage the patient pre-operatively, intraoperatively, and post-operatively.

The most complex procedure I personally performed were microsurgical limb-reimplantations of the upper extremity for which I received certification to perform. These cases were done in two person teams, and lasted from twelve to twenty four hours. They were a feat of endurance. This was several years ago, and would not attempt to hold myself out as capable of doing so today. I also was residency trained in general surgery, and many abdomen cases could vary in their complexity, some lasting many hours. I learned a great deal about total patient management, at a different time, a different era.

I carried that training over to doing foot surgery for a brief period of time. It was fun, but would never consider calling myself a "foot surgeon" if I was not first trained in general surgery first.

Podiatrists who aspire to be "surgeons" may want to explore some of the philosophies of surgery, general medicine, and spend every spare moment working on their dexterity, one hand ties, and wholly understanding the biochemistry and physiology of inflammation and repair.

I reattached one foot. It was with a podiatrist. That podiatrist did not perform another, she is currently a retired orthopedic surgeon (she went to med school after podiatry), and encouraged me to write this post.

Apparently that experience encouraged her to take her education beyond the foot.

 

[PatchAdamsFan]

:troll:

 

[Ferocity]

Why?

Traditionally podiatrists are not employed by hospitals, do not spend long days laboring over a surgical case, and the complexity of any surgery is contingent upon the necessity. The situation is boss, and the most complex cases involve multiple trauma, often involving the bone, muscle, tendons, and nerve, finally the most complex surgery is the severed limb, which if conditions permit, is reattached. Although many podiatry trainees are led to believe that some day they will be engaged in performing multiple complex surgeries, the reality is that they will not. Podiatrists will, as they traditionally have been will be treating bunions, hammertoes, and other forefoot surgeries to earn a living. These patients do not "fall from trees" as they are elective procedures, and the patient base must be nurtured, developed, and grown. The misconception many podiatrists have is that when a patient suffering multiple trauma has a foot or ankle injury the podiatrist on staff will be called is not as likely as the general trauma surgeon, or someone from orthopedics. Why? Because in multiple trauma cases there are several concurrent injuries the patient may suffer, and the podiatrist is not equipped, or licensed to evaluate, or treat. In real life practice podiatrists will find a set of procedures they are comfortable doing, often hallux valgus, arthroplasties, neuromas, and a few others and perform them throughout their career. They will hone their skills to these procedures to such extent that patients will be comfortable when the question: "How many of these have you done lately?" This question is mostly asked by patients routinely in real life.

If someone performs one, two, or three complex surgeries this would not qualify them as an expert. Doing a complex procedure every now and then does not an expert make. Unless the practitioner is familiar with tissue handling, via a general surgery, and/or orthopedic surgery residency it is unlikely they will have the training to manage the patient pre-operatively, intraoperatively, and post-operatively.

The most complex procedure I personally performed were microsurgical limb-reimplantations of the upper extremity for which I received certification to perform. These cases were done in two person teams, and lasted from twelve to twenty four hours. They were a feat of endurance. This was several years ago, and would not attempt to hold myself out as capable of doing so today. I also was residency trained in general surgery, and many abdomen cases could vary in their complexity, some lasting many hours. I learned a great deal about total patient management, at a different time, a different era.

I carried that training over to doing foot surgery for a brief period of time. It was fun, but would never consider calling myself a "foot surgeon" if I was not first trained in general surgery first.

Podiatrists who aspire to be "surgeons" may want to explore some of the philosophies of surgery, general medicine, and spend every spare moment working on their dexterity, one hand ties, and wholly understanding the biochemistry and physiology of inflammation and repair.

I reattached one foot. It was with a podiatrist. That podiatrist did not perform another, she is currently a retired orthopedic surgeon (she went to med school after podiatry), and encouraged me to write this post.

Apparently that experience encouraged her to take her education beyond the foot.

Marvelous post. Thanks for taking the time to let us know the real truth.

 

[Ferocity]

Jive could you tell us some more really cool stories of real foot surgeons?

 

[jivecrudley]

Jive could you tell us some more really cool stories of real foot surgeons?

Mr. Ferocity, I have told you mine, let's read about yours?

 

[Ferocity]

Mr. Ferocity, I have told you mine, let's read about yours?

I have none, but I hope to someday become a real foot surgeon. Can you give me some advice on becoming a real foot surgeon?

 

[jivecrudley]

I have none, but I hope to someday become a real foot surgeon. Can you give me some advice on becoming a real foot surgeon?

If you want to do "real" surgery, rather than manage local manifestations of disease, or elective procedures I would suggest attending medical school, and a residency in surgery.

Maybe qualifying your definition of "real" would be helpful. Hammertoe, bunion, and non-life threatening procedures may be within the scope of podiatry, but with the evolving changes of the healthcare delivery model in the US, which has been traditionally disease management oriented, the question to be asked would be this: What level of understanding human medicine will be required to manage the full body rather than an appendage.

 

[zdlamkin8195]

If you want to do "real" surgery, rather than manage local manifestations of disease, or elective procedures I would suggest attending medical school, and a residency in surgery.

Maybe qualifying your definition of "real" would be helpful. Hammertoe, bunion, and non-life threatening procedures may be within the scope of podiatry, but with the evolving changes of the healthcare delivery model in the US, which has been traditionally disease management oriented, the question to be asked would be this: What level of understanding human medicine will be required to manage the full body rather than an appendage.

Troll...

IF you are a "real" surgeon - it must suck to be so sad and lonely that you get up early on a Sunday morning to log onto podiatry forums to "educate" people...no one buys it.

Please stop.

 

[Ferocity]

If you want to do "real" surgery, rather than manage local manifestations of disease, or elective procedures I would suggest attending medical school, and a residency in surgery.

Maybe qualifying your definition of "real" would be helpful. Hammertoe, bunion, and non-life threatening procedures may be within the scope of podiatry, but with the evolving changes of the healthcare delivery model in the US, which has been traditionally disease management oriented, the question to be asked would be this: What level of understanding human medicine will be required to manage the full body rather than an appendage.

I just want to cut people. Please advise.

 

[pacpod]

Just curious: For podiatrist, how long does the average procedure take? How long does one of the longer procedures take?

As far as the procedures that I have seen, most seem to be about 45 min to an hour. The longest procedure I've seen lasted 3 hours.

On another note, please do not engage users that bother you for the sake of argument. Please use the ignore feature for those users.

 

[podiatrysurgery]

I took 1 hour one time to clip this patients toenails

 

[Dommo]

do portraitists do amputations?

 

[PMSIII]

Definitely revisional surgery involving infected hardware in the foot and ankle.

 

[dorsiflexor]

So?

See the residency review thread... AB provided a ton of insight to every program he visited.

PMSR/RRA Residency Reviews

 

[I post PRN]

See the residency review thread... AB provided a ton of insight to every program he visited.

PMSR/RRA Residency Reviews

I don't think he really cares, I just think he is trolling my boy anklebreaker.