Transmetatarsal Amputation and TAL for Gangrene of Forefoot

[Jaxxon10]

R u okay now?

[BigWater59]

dang so little blood is this a cadaver?

[BigWater59]

WOW that looks a lot like frost bite

[MrGulpz]

What I would like to know is where is the FUCKING BLOOD?!?!??!?! I'm so confused, if someone chopped off my toes I would bleed everywhere!

[corwin11412]

This is what diabetes will do to you if you don't take care of yourself. Good lord...

[MrParkinthedark]

Dude what the fuck is wrong with me, why am I watching this before I go to bed, holy shit, fuckin' youtube god damn it FUUU-

[HappyBubblesSoap]

Nice work Dr. DeHeer.. Need a better camera guy.. lol

[narutouchihaism]

thats one fucked up foot

[homeyhomedawg]

how much money do you make, just curious

[damagedgoods1975]

I was surprised to see there was not much blood.

[narutouchihaism]

@damagedgoods1975 that because gangrene is suppose cut off blood supply and kill tissues

[breaneainn]

Amputation operations are expensive, costs you an arm and a leg.

[brl17shots]

1) doesn't sound like a very professional operating room.

2) is there a monkey working the camcorder

[bsm6776]

diabetes?

[toddpf]

2:34 "Damn it stinks"

[ahmarsidd]

Pink Floyd in the background FTW!! :)

[thegameaf]

Last time I eat and watch these videos at the same time

[XxW0nderBr3adxX]

Wow that was really cool. Made me cringe because of the mushy sounds, but totally rewarding.

[herogodman76]

All respect man if this what you have to do. I wouldn't be able to cut a mans foot in half.

[padeheer]

@herogodman76 This case required nothing less than a midfoot amputation. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[judithk]

Oddly, the only part of this video that made me cringe was when the Dr. was cutting the achilles tendon.

[padeheer]

@judithk Lengthening of the Achilles tendon is crucial with this procedure to prevent ulceration of the distal aspect of the amputation site. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[padeheer]

@judithk Lengthening of the Achilles tendon is crucial with this procedure to prevent ulceration of the distal aspect of the amputation site. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[padeheer]

@judithk Lengthening of the Achilles tendon is crucial with this procedure to prevent ulceration of the distal aspect of the amputation site. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[nicholasgerling]

eww finng gross eww ewe ewe

[padeheer]

@nicholasgerling Surgery videos are not for everyone. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[kingofallwhites]

It doesn't seem right for people to be laughing and joking during this. Imagine if that was your wife or your mother or your child on the table? Would you be laughing out loud about the smell?

[padeheer]

@kingofallwhites First that is not me laughing, it is hospital staff and sales reps. I have no control over them and I am concentrating on what I am doing. Sometimes, humor makes difficult situations easier to deal with. Just saying. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[Grkgod4uturks]

muuaaaa holy fucking shit you doctor's are butchers and normal at the same time. freakkks

[padeheer]

@Grkgod4uturks Thanks, I think? Best Wishes.

Dr. Patrick A. DeHeer, DPM

[jameskim0517]

what happened? frost bites

[padeheer]

@jameskim0517 Arterial disease called PAD and diabetes resulting in gangrene of the toes. Hope this helps. Best wishes.

Dr. Patrick A. DeHeer, DPM

[kim75libra]

Awesome ! I am podiatrist assistant. I remove and change dressings when they come in for post op. Every now and then the doc is nice enough to let me remove the sutures. I have never been involved in assisting in these surgeries but very interested in watching it happen. Sadly we see alot of this.

[padeheer]

@kim75libra Glad the videos are of help for you. That was one of my intentions when decided to start posting them. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[yognaut513]

holy shit...

[padeheer]

@yognaut513 Surgery videos are not for everyone. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[IWantToBelieve101]

*gag*

[padeheer]

@IWantToBelieve101 Surgery videos are not for everyone. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[kpeavey2]

This aint for me.

[padeheer]

@kpeavey2 Surgery is not for everyone for sure. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[KingOfFetusland]

I love how well the sound effects are picked up, every little squishy sound <3

[padeheer]

@KingOfFetusland I try to give a real-life experience of the operating room. Best wishes.

Dr. Patrick A. DeHeer, DPM

[HuskySniping]

ohhhh my god. i cant beleive this is on youtube....they cut off half of a mans foot...

[dudejrod]

@HuskySniping omg husk. why are you watching these things?

[ReLiSniping]

@dudejrod lol our whole clan is commenting on this

[dudejrod]

@ReLiSniping LOL i know.

[padeheer]

@HuskySniping I use this video for teaching others as well as to get the attention of diabetic patients to take care of their feet so they do not get to this point. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[DrTashen]

I did a surgery like this today on a dog's leg.

I am a vet tough.

[padeheer]

@DrTashen Amputations are unrewarding under any circumstance I am sure you agree. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[gnortonshores]

Very interesting video. I find medical videos fascinating.

[padeheer]

@gnortonshores Thank you, best wishes.

Dr. Patrick A. DeHeer, DPM

[SOULBIKERFLY]

its not bleeding because of the gangrene and also I think they put a tourniquet.

[padeheer]

@SOULBIKERFLY Yes we use a tourniquet and that eliminates bleeding during the surgery. Best wishes.

Dr. Patrick A. DeHeer, DPM

[padeheer]

@SOULBIKERFLY Partially, but also because I use a tourniquet during surgery. Best wishes.

Dr. Patrick A. DeHeer, DPM

[NANANANAification]

yes, its not bleeding because Gangrene is a poor circulation of blood 

[nmg2192]

I was yelling while watching this omg and i just threw up. :U

[padeheer]

@nmg2192 Surgery videos are not for everyone. Best wishes.

Dr. Patrick A. DeHeer, DPM

[jcraftmemphis]

Dr. DeHeer, very interesting. I've always been interested in being a surgeon. Unfortunately, I'm graduating in a few weeks with an accounting degree. Fascinating stuff, and I also like The Postal Service tunes in the background.

Thanks for posting.

[padeheer]

@jcraftmemphis You are welcome. It is never too late to change careers. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[x3AnimeEGG]

My friends lost her big toe cause it got cut off by a kitchen accident and she has a fake one

[padeheer]

@x3AnimeEGG We do not use prothesis for the hallux usually just a toe filler within the shoe. Best wishes.

Dr. Patrick A. DeHeer, DPM

[TheBlenderanimations]

Shrek, I can't feel my toes! Wait... I don't have any toes

[padeheer]

@TheBlenderanimations This video has been posted to reinforce to those with diabetes and peripheral arterial disease the importance of taking care of themselves and their feet. Best wishes.

Dr. Patrick A. DeHeer, DPM

[GUAVcis06]

Strange... Why isnt it bleeding?

[padeheer]

@GUAVcis06 I use a tourniquet during surgery but also this patient had very poor circulation and after I let the tourniquet down to examine blood flow, there was very poor flow.

[padeheer]

@SophieStarburst This procedure did not heal do to poor circulation and the patient required a higher level amputation. Best wishes.

Dr. Patrick A. DeHeer, DPM

[jeyshax]

What were the incisions on the heel for?

[padeheer]

@jeyshax To lengthen the Achilles tendon, which is crucial for this procedure. This is a tendon balanacing approach that yields much better results than not doing it. Best wishes.

Dr. Patrick A. DeHeer, DPM

[xXhawaiianXD]

How did he Get that

[padeheer]

@xXhawaiianXD This was combination of peripheral arterial disease and diabetes. It can lead to tragic results. I hope this makes those with diabetes take an active role in their disease management. Best wishes.

Dr. Patrick A. DeHeer, DPM

[wenh08]

Fake & gayy

[padeheer]

@wenh08 This is absolutely not fake. This is a real patient with a real surgery. Peripheral arterial disease and diabetes can be tragic and that is why I posted this video. Best wishes.

Dr. Patrick A. DeHeer, DPM

[padeheer]

@lintlinter Surgery is not for everyone to watch. Best wishes.

Dr. Patrick A. DeHeer, DPM

[Clubman1316]

is that foot... dying?

[padeheer]

@Clubman1316 Yes because of peripheral arterial disease or lack of blood flow. It is more common than you would think. Medicine has made great strides in treating this, but unable to cure everyone. Best wishes.

Dr. Patrick A. DeHeer, DPM

[SekouFox]

Do you do this procedure often? It seems that your are moving quite fast.

[sraldleif]

So much for the term 'surgical precision' you just hacked into that thing.

[ternel]

@sraldleif Most of the tissue is already dead and just needs to be removed. Notice how there is minimal bleeding. It is dead, rotting flesh that needs to be removed. Looks horrible but the 'hacking' is just removing the big pieces before getting into the finer parts between the living and dead tissue.

[padeheer]

@sraldleif The delicate part of this procedure comes with the fine tuning of the bone length and debulking of the flap, and finally the closure. It looks like hacking, but it is more experience that allows me to move quickly with percision to get to a viable wound. Best wishes.

Dr. Patrick A. DeHeer, DPM

[xXhawaiianXD]

The zombie within him is awakening

[padeheer]

@xXhawaiianXD Gangrene is what this patient had and it is do to vascular compromise. Best wishes.

Dr. Patrick A. DeHeer, DPM

[padeheer]

@theshugchannel This is a severe case of peripheral vascular disease. Importanat lession in blood sugar control and maintaining healthy arterial system. Best wishes.

Dr. Patrick A. DeHeer, DPM

[theshugchannel]

@padeheer thanks

[grahamphillipsluva]

how do you keep ur food down?

[padeheer]

@grahamphillipsluva Surgery is not for everybody. Best wishes.

Dr. Patrick A. DeHeer, DPM

[padeheer]

@blackops777 They can have a similar appearance. Best wishes.

Dr. Patrick A. DeHeer, DPM

[ToniHenkel]

Nur für Hartegesonnte Menschen :P

[padeheer]

@ToniHenkel Not sure what that means, best wishes.

Dr. Patrick A. DeHeer, DPM

[KrautGoesWild]

@padeheer It can be translated in many ways:

"Only for people with a strong stomach!"

"Not for the faint of heart!"

"Do not watch unless you want to throw up on your PC!"

(It pays off to have lived 20 out of my 36 years in Germany - that´s how I even got this nickname xD )

Good Luck, Sir!

KGW

[MajorIron]

Do I hear Pink Floyd's Us and Them in the background??

[padeheer]

@MajorIron Probably, I usually just listen to classic rock during surgery. Usually anesthesia picks the music or the nurses. Best wishes.

Dr. Patrick A. DeHeer, DPM

[KrautGoesWild]

How long do these amputation normally take?

[padeheer]

@KrautGoesWild The vary, but about one hour. Usually there is some tendon lengthenings or transfers done at the same time. Hope this helps. Best wishes.

Dr. Patrick A. DeHeer, DPM

[KrautGoesWild]

@padeheer Thank you, doctor! Cases like this are very interesting for me ever since some 12 years ago, I almost lost my right leg when two pitbulls attacked me in Chemnitz, Germany.

Only thanks to the considerable wealth of my godfather my leg is still there - but I can´t bend my knee anymore.

[padeheer]

@KrautGoesWild You are welcome, I am sorry to hear about the severe injury you have had but I am glad to hear you are getting along well. Best wishes.

Dr. Patrick A. DeHeer, DPM

[jamriche]

Scrub nurse: How do you want it labeled?

Podiatrist: Uh, foot.

I love it!!

[padeheer]

@jamriche I am usually so zoned in on what I am doing, I often do not even think about what I am saying. Just a slice of real OR time. Best wishes.

Dr. Patrick A. DeHeer, DPM

[kirbyman1kanden7pf]

straight out of a horror movie.

[padeheer]

@kirbyman1kanden7pf Amputations are unfortunate but sometimes the only choice. Best wishes.

Dr. Patrick A. DeHeer, DPM

[disiscrazymon1]

I just have to say thanks. All of your videos are done superbly. I use them to educate my adolescent students about diabetes. Also, you take the time to informatively respond to posts from professionals and lay people alike.

[choppamx]

Great Video,

How do you decide at what level to amputate? Is it based on angiography, TcPO2 or something else?

How do you decide at what level perfusion is adequate for the surgical wound to heal?

[padeheer]

@choppamx I used skin perfusion pressure to determine oxygen levels at multiple areas on the foot. I also deflate the tourniquet to evaluate intra-operative bleeding. I hope this helps. Best wishes.

Dr. Patrick A. DeHeer, DPM

[FarmingFarmer]

@padeheer thanks for the info. I was just joking about the comment you made. I'm sure you are well qualified & your patients are in good hands

[FarmingFarmer]

how did the foot get in such shape?

[padeheer]

@FarmingFarmer This was due to peripheral arterial disease and gangrene development.  This is why it is so important to monitor for arterial disease if you have any risk factors. Best wishes.

Dr. Patrick A. DeHeer, DPM

[FarmingFarmer]

"do you have something to put this in" - how reassuring

[padeheer]

@FarmingFarmer Not sure what you are saying but to clarify, anything specimen must be sent to the pathologist. Typically the containers for my cases are very small, and this specimen would not fit into them. Secondly, this is considered contaminated and you do not want to place it in the sterile field. Finally, we you are doing a surgery you are very zoned in on what you are doing, so my verbiage is not high on my list of priorities. Best wishes.

Dr. Patrick A. DeHeer, DPM

[cowboys430isback]

i didnt know podiatrists handle problems such as this one.

[padeheer]

@cowboys430isback Yes we do, you do not seem to think podiatrist do much do you?

Dr. Patrick A. DeHeer, DPM