Vladimirov-Mikulicz Operation

VLADIMIROV-MIKULICZ OPERATION, an osteoplastic resection of the foot, proposed by Vladimirov in 1872 and by Mikulicz in 1873. The incision begins at the tuberosity of the navicular bone (os naviculare), runs transversely across the sole to the outer edge of the foot, and ends one transverse finger-breadth behind the tuberosity of the fifth metatarsal bone. Two other incisions run from the ends of the first through the middle of both malleoli, in the middle of the inner and outer surfaces of the lower leg. The Chopart joint (see Foot) is opened from below, and its lateral and dorsal ligaments are severed.

All soft parts of the anterior-dorsal surface of the foot and lower leg, bounded by the lateral incisions, are detached. Then, the soft tissues of the posterior surface of the lower leg, including the Achilles tendon, are severed at the level where the incisions end; after cutting the periosteum on the bones of the lower leg, the bones are sawn through (see line a).

After ligating the vessels, the cartilage and a small layer of bone are chipped away with a chisel from the posterior surface of the navicular and cuboid bones (os cuboideum) (see line b), which, after the removal of the calcaneus and talus, are brought into contact with the sawed surface of the tibia and fibula. Sutures and a splint bandage are applied. As a result of the operation, the limb is shortened by 3–4 cm. A horse foot (pes equinus) is produced—the patient walks on the heads of the metatarsal bones. The operation has limited application. Indications for the Vladimirov-Mikulicz operation are: tuberculosis of the tarsal bones and the lower end of the tibia and fibula, and injuries and tumors of the heel. The functional result of the operation is good.