Microsurgery in Podiatry

MICROSURGERY is intricate surgery performed using miniaturized instruments and a magnifying instrument, preferably portable such as a variant of Loupes, or a fixed microscope.
In podiatry, such microsurgery is indicated in repair of nerve entrapment, microvasculature repair, and skin-muscle-tendon grafting or repair.
Typically, deep neurovasculature travels together: comitante vein, artery, and nerve. Proper anatomy identification plays a major role in differentiating artery from vein. A surgeon can use several methods, one being the simplest by blocking vasculature flow to the area in question and slowly releasing the flow observing which structure fills back: first artery fills up, then vein in retrograde fashion. This leaves out the nerve.
In a nerve entrapment, scared tissue extends along its tract sometimes strangulating surrounding tissue.
In my future practice and procedures, I will seek an instant identification of nerve structure from surrounding tissue. A simple chemical marker, yet non-reactive to surrounding tissue is in demand. Its application should vary from being injected or simply applied directly in a sterile wash from a dispensing syringe.
The function of the marker is to perform the following: quickly embed within the epineurium of the questionable nerve structure, and become easily visible either by itself or under a specific visible light spectrum, i.e. UV. It is important to realize this nerve identification is non-reactive to surrounding tissue including epineurium. Once the nerve tissue is identified by the protein marker, it is freed from surrounding tissue using microsurgery, and to prevent further scaring, a layer of regenerated tissue matrix is applied along the nerve sheath.
Typically the scar surrounding the nerve is made primarily of collagen fibers, extracellular proteins with triple helical structures making up the fibrillar and microfibrillar network of extracellular matrix. When nerve ending is damaged, the normal extracellular matrix synthesis is up-regulated. It turns out this hinders the regeneration of new nerve sprouts to reach new interface(s). With microsurgery, new avenues of nerve entrapment repair are possible. Currently there is no one single successful procedure. The use of protein epineurium marker as adjuvant procedure should help the successful identification of healthy nerve tissue from surrounding extracellular matrix allowing successful repair without unnecessary damage to healthy nerve tissue.