Vladimirova-Mikulicz Operation

VLADIMIROVA-MIKULICZ OPERATION, osteoplastic resection of the foot, proposed by Vladimirov in 1872 and Mikulicz in 1873. The incision begins from the tuberosity of the navicular bone (os naviculare), goes transversely across the sole to the bone on the outer edge of the foot, and ends on the transverse toe behind the tuberosity of the fifth metatarsal bone. Two other incisions go from the ends of the first through the middle of the medial and lateral malleoli, in the middle of the inner and outer surfaces of the leg. The Chopart joint (see Foot) is opened from below, its lateral and dorsal ligaments are cut, and all soft parts of the dorsal surface of the foot and leg, limited by the lateral incisions, are separated. Then the soft tissues of the posterior surface of the leg are cut, including the Achilles tendon, at the level of the end of the incisions; after periosteal incisions on the bones of the leg, the bones are sawn-

off (see line a). After vessel ligation, the cartilage and a thin layer of bone are chiseled off the posterior surface of the navicular and cuboid bones (os cuboideum) (see line 6), which, after removal of the calcaneus and talus, are brought into contact with the saw cut of the tibial bones. Sutures are applied and a splint bandage is applied. As a result of the operation, the limb is shortened by 3-4 cm. A clubfoot (pes equinus) results - the patient walks on the heads of the metatarsal bones. The operation has limited application. Indications for the V.-M. operation are: tuberculosis of the tarsal bones and lower ends of the tibial bones, injuries and tumors of the heel. The functional result of the operation is good.