Partial Plantar Fasciotomy Using Endoscope with Inner Two-Channel Portals Produced Better Functional Outcomes Than Mini-Open Procedures for The Treatment of Refractory Plantar Fasciitis

Objective: To evaluate the clinical efficacy of partial fasciotomy using two-channel arthroscope in the treatment of refractory plantar fasciitis, and to compare it with the clinical effects of partial fasciotomy using minimally invasive open. Methods: Sixty-two patients with refractory fasciitis admitted from January 2015 to July 2017 were randomly assigned to the arthroscopic group and the open surgery group. Arthroscopic partial section was performed using endoscope with inner two-channel portals. The open surgery group underwent partial sacral fascia resection with minimally invasive medial incision. Then compare the pain visual analogue scale (VAS), the American foot and ankle surgery association score (AOFAS), the calcaneodynia score (CS), and the medical outcomes short form 36-item (SF-36) health survey between the two groups. Results: All patients were followed up for at least 24 months, and there was no difference in follow-up between two groups. At the last follow-up, the patient's plantar pain symptoms completely disappeared. There was no recurrence of the bone spurs, and the ankle and foot movements were normal. There was no statistically significant difference in VAS, AOFAS, and CS scores between the two groups. The SF-36 score of the arthroscopy group is significantly higher than the open surgery group. Conclusions: Arthroscopic partial fascia resection with medial access provides better clinical outcomes than the open minimally-invasive surgery. Arthroscopic partial fasciotomy with the medial access provides a new option better than the open minimally-invasive surgery for postoperative daily life.

Mastering the Central Line Placement Techniques Through Effective Resident Training Environment

Catheterization of the central vein is one of the fundamental procedures in anesthesiology. Mastering different methods of central venous access is an important part of resident training. At the initial stage residents should master the way of high medial access to the right internal jugular vein that is one of the simplest techniques with the lowest risk of complications for a patient. The operating room can be an optimal training environment where first independent puncture attempts are performed in a stable patient undergoing surgical intervention under general anesthesia. The next stage of training should involve access to other central veins as well performing the procedure in a conscious patient.