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To Dr. Ed, re: Dr. Dellon's technique

Posted by Terri on 8/14/04 at 08:17 (157822)

Dr. Ed,

On Aug 9th you described Dr. Dellon's method during TTS surgery was to tease apart the nerve and look for scar tissue between the fibers. My question was, how is the myelin coating around that nerve preserved? If not, will it re-generate? What are some of the drawbacks of doing this?

Any reply would be appreciated.

Re: To Dr. Ed, re: Dr. Dellon's technique

Darlene on 8/14/04 at 11:15 (157838)

Terri:

I got a pamphlet from Dr. Dellon's office on tts. If I'm reading it correctly, he doesn't always mess with the nerve. It says 'If there is scarring within the posterior tibial nerve or its branches, this is relieved by the technique of internal neurolysis. During internal neurolysis, the outer layer of the nerve wrapping is opened and the scar tissue is removed from within the nerve.'

Darlene

Re: To Dr. Ed, re: Dr. Dellon's technique

Ed Davis, DPM on 8/14/04 at 15:16 (157865)

Terri:
Keep in mind that we a discussing something that doctors don't agree on -- ie. we are basically in uncharted territory. Some doctors are convinced that the technique is best done via a 'no touch' technique; that is, handle the nerve as little as possible in the surgery.

The myelin sheath does regenerate -- it is the fibers themselves that have the poorest regeneration ability so if they are to be disturbed in surgery it must be done so with the utmost of care. The drawbacks of 'handling' the nerve may include permanent damage to nerve fibers. Apparently, Dr. Dellon feels that his microsurgical skills are exceptionally well developed and, as such, the technique works in his hands. The vast majority of tarsal tunnel releases are performed by orthopedists and podiatrists, not neurosurgeons as Dellon. I would, generally speaking, only expect a neurosurgeon to have sufficient microsurgical skills to do the fiber 'separation.' I have talked to numerous neurosurgeons and they appear to have no interest in getting into the area of tarsal tunnel surgery. As such, I think that Dellon's specific approach will remain something in his hands with very few practitioners doing the nerve 'manipulation' part of the surgery.
Ed