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TTS revison surgery question for Dr. Ed and others

Posted by elliott on 7/11/02 at 15:58 (089490)

As a rule, TTS revision surgery is especially tricky, as the increased scar tissue from the second procedure is even more likely to generate a return of symptoms. Also as a rule (I've seen this explicitly and never seen otherwise), for a revision they re-open along the entire old incision line and re-check for entrapment all along the posterior tibial nerve and its branches already released the first time.

If the patient knows, i.e. can make a very convincing claim that he/she knows, *exactly* where his/her TTS entrapment is down to an area the size of a nickel, e.g. the pain increases only when something presses at that one little spot, and when rubbing hard only there but nowhere else severe electric shocks are generated into arch, big toe, and first web space, and say in this case that area is located just dorsal to the previous incision line at its distal end (this is all hypothetical of course :-)), is it possible to have a revision surgery where they make just a small incision right there at that one spot (assuming they don't need to widen it based on what they find), thereby decreasing the odds of the scar tissue problem all along the nerve? This type of surgery would sound less risky and more apealing than a full-blown re-release or vein wrap. Thanks for any input.

Re: TTS revison surgery question for Dr. Ed and others

J. King on 7/11/02 at 18:40 (089500)

That sounds like major surgery. Yippes!

Re: TTS revison surgery question for Dr. Ed and others

Ed Davis on 7/12/02 at 10:39 (089548)

Elliott:

Sounds like a reasonable concept. One must weigh the advantages of going after the area that is most problematic with the potential for 'undertreatment' of other areas which may be involved but to a lessor extent. Most clinicians, I believe, would be inclined to a more aggressive approach.
Ed

Re: thanks for your input (nm)

elliott on 7/12/02 at 16:01 (089576)

.

Re: TTS revison surgery question for Dr. Ed and others

J. King on 7/11/02 at 18:40 (089500)

That sounds like major surgery. Yippes!

Re: TTS revison surgery question for Dr. Ed and others

Ed Davis on 7/12/02 at 10:39 (089548)

Elliott:

Sounds like a reasonable concept. One must weigh the advantages of going after the area that is most problematic with the potential for 'undertreatment' of other areas which may be involved but to a lessor extent. Most clinicians, I believe, would be inclined to a more aggressive approach.
Ed

Re: thanks for your input (nm)

elliott on 7/12/02 at 16:01 (089576)

.