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1 ™ AM SURGICAL Uniportal Decompression of the Intermetatarsal Nerve SURGICAL TECHNIQUE

2 UDIN Uniportal Decompression of the Intermetatarsal Nerve SURGICAL TECHNIQUE UDIN Uniportal Decompression of the Intermetatarsal Nerve Surgical Technique as described by Gary M. Lepow, DPM, MS Lepow Foot and Ankle Specialists Houston, TX Proper surgical procedures and techniques are necessarily the responsibility of the medical professional. Each surgeon must evaluate the appropriateness of the techniques based on his or her own medical training and expertise. INCISION Make a 1cm vertical web space incision. Gently dissect the anatomy to identify the distal border of the deep Transverse Intermetatarsal Ligament (TIML). CREATING THE PATHWAY Using blunt dissection, palpate the distal edge of the TIML and palpate the plantar surface of the TIML in a proximal direction. Introduce the elevator into the previously created subligamentous space and palpate the plantar surface of the TIML in a proximal direction. INTRODUCTION OF DISSECTING CANNULA Introduce the obturator/cannula assembly into the subligamentous space in a proximal and plantar-grade direction to the deep TIML. INTRODUCTION OF ENDOSCOPE Remove the obturator from the assembly and introduce the 4 mm, 30° scope through the cannula to visualize the TIML. NOTE| Throughout the procedure, whenever necessary, sterile absorbent swabs may be used to remove fluid from within the cannula. VISUALIZATION OF THE DEEP TRANSVERSE INTERMETATARSAL LIGAMENT (TIML) At this time you should be able to visualize the transverse fibers of the TIML. If visualization is obscured in any way, remove the endoscope and introduce the rasp. Make several passes to clear your view. Reintroduce the scope. NOTE| If you are still unable to obtain adequate visualization after using the rasp, reintroduce the obturator and remove the obturator/cannula assembly. Reintroduce the assembly to gain better placement by hugging the undersurface of the TIML.

3 BLADE ASSEMBLY Attach the scope-mounted blade to the endoscope using the locking device (see diagram below), with the viewing angle of the endoscope oriented towards the blade. DIVISION OF TIML Introduce the scope-mounted blade into the cannula and, as you observe the monitor, divide the TIML by advancing the blade through the cannula in a proximal direction. It typically requires one pass to divide the TIML. VERIFICATION OF DIVISION Remove the scope-mounted blade from the endoscope and reintroduce the scope into the cannula. The divided edges of the TIML should now be visualized along its entire length. Confirm a complete division. | FIGURE 1 | FIGURE 1 BLADE ASSEMBLY AND USE OF LOCKING DEVICE WARNING: Endoscopic Blades Can Only Be Used With A 4mm, 30° Endoscope Scope-Mounted Blade Insert Flared Ring Locking Device End Endoscope Scope-Mounted Blade Insert Locking Device Locked Scope-Mounted Blade WARNING Open The disposable scope-mounted blade is designed for single use only. Resterilization may result in blade detachment, potentially causing harm to the patient. Endoscope

4 ORDERING information AM UDIN INSTRUMENT KIT AMPFKIT1 Also available AM043001 AM Endo Blade (single pack) AM043005 AM Endo Blade (5 pack) Locking Device Part # AM960004 Rasp Part # AM330003 Obturator Part # AM330001 Slotted Cannula Elevator Part # AM330002 Part # AM330006 One Company. Focused on Foot & Ankle. GRAFTJACKET® Regenerative Tissue Matrix SIDEKICK® OSTEOSET® DARCO® CHARLOTTE® External Fixation Resorbable Mini Bead Locked Plating System Foot & Ankle Systems Wright Medical EMEA Wright Medical Technology, Inc. Wright Medical UK Ltd. Unit 1, Campus Five Atlas Arena, Australia Building 1023 Cherry Road Memphis, TN 38117 Letchworth Garden City Hoogoorddreef 7 Hertfordshire SG6 2JF 800 238 7117 1101 BA Amsterdam the Netherlands 901 867 9971 United Kingdom www.wright.com 011 31 20 565 9060 011 44 (0)845 833 4435 ™Trademarks and ®Registered marks of Wright Medical Technology, Inc. 013270A_27-Oct-2015 ©2015 Wright Medical Technology, Inc. All Rights Reserved.

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