The Origins of the Name: Victor Bonney
The dual application of the 'Bonney procedure' is tied to the influential British gynecologist and surgeon Victor Bonney (1872–1953), who made significant contributions to medicine in the early 20th century. While primarily known for his work in gynecology, his name became attached to innovations in other fields through his collaborators and surgical legacy. The term can refer to a technique for uterine myomectomy, a foot surgery, or even an antiseptic dye, highlighting his broad impact on surgical practice.
The Kessel-Bonney Osteotomy
This procedure, also known as a Kessel-Bonney operation, is a form of foot surgery performed to treat hallux rigidus, a type of degenerative arthritis affecting the big toe joint (the first metatarsophalangeal joint). The aim of the surgery is to relieve pain, increase the toe's range of motion, and slow the progression of the arthritic process, preserving the joint for as long as possible.
Indications and Surgical Technique
- Hallux Rigidus: The procedure is typically indicated for patients with mild to moderate hallux rigidus who have not found relief from conservative treatments like special footwear or pain medication.
- Joint Elevation: The surgery involves removing a wedge-shaped section of bone from the base of the big toe. This elevates the toe, which effectively increases the arc of movement in the joint and helps the patient walk more comfortably.
- Osteophyte Removal: At the same time, any bony overgrowth, known as osteophytes, around the joint is removed in a process called cheilectomy.
- Fixation: The repositioned bone is then secured using a wire or screw to allow it to heal properly.
Postoperative Recovery
Following a Kessel-Bonney osteotomy, patients can expect a few weeks of recovery, which typically involves wearing a special postoperative shoe. Full weight-bearing is often immediate, though crutches may be necessary initially. Physical therapy is often prescribed to help regain strength and flexibility in the toe joint.
The Bonney Myomectomy Technique
In gynecology, the 'Bonney procedure' refers to a technique developed by Victor Bonney for performing a myomectomy, the surgical removal of uterine fibroids while preserving the uterus. Bonney was a strong advocate for fertility-preserving surgeries at a time when hysterectomy was a more common treatment for fibroids.
The Bonney Myomectomy Clamp
The key innovation of this technique was the Bonney myomectomy clamp, a specialized instrument designed to temporarily compress the uterine blood vessels. This was a crucial development, as myomectomies were notoriously associated with significant blood loss, which made surgeons hesitant to perform them. By temporarily blocking the blood supply, Bonney's clamp created a relatively blood-free surgical field, allowing for more precise and safer removal of the fibroids.
Modern Relevance
While the specific Bonney clamp is rarely used in modern practice, the principles Bonney established—including meticulous hemostasis and techniques for closing the uterine incision to prevent adhesions—are still fundamental to modern gynecological surgery. His work helped popularize the myomectomy, ensuring that women had a fertility-sparing option for treating fibroids.
Bonney's Blue Dye
Victor Bonney's name is also associated with an antiseptic solution he developed during the First World War. Known as Bonney's blue, this dye was a solution of crystal violet and brilliant green that was used to sterilize and stain the skin and vaginal canal before gynecological procedures. The dye helped define the surgical area, particularly when the vagina needed to be opened during a hysterectomy, and reduced the risk of postoperative infection. Bonney's blue is still used today in various medical and surgical applications, a testament to its effectiveness.
Comparison of the Bonney Procedures
| Aspect | Kessel-Bonney Osteotomy | Bonney Myomectomy Technique |
|---|---|---|
| Medical Field | Orthopedic Surgery (Podiatry) | Gynecological Surgery |
| Purpose | Treat big toe arthritis (hallux rigidus) by increasing joint mobility and reducing pain. | Remove uterine fibroids while preserving the uterus for future fertility. |
| Key Tool | A wedge osteotomy and cheilectomy, with fixation using wires or screws. | The use of a specialized clamp (Bonney myomectomy clamp) to control bleeding. |
| Associated Condition | Hallux Rigidus | Uterine Fibroids (Myomas) |
| Historical Context | Part of broader surgical developments for foot deformities. | Pioneering fertility-sparing surgery in the early 20th century. |
| Modern Usage | Still performed today for specific cases of big toe arthritis. | The specific clamp is largely historical, but the principles of bleeding control are standard practice. |
Conclusion
In conclusion, the term 'Bonney procedure' is not singular but represents a range of significant medical contributions. While the Kessel-Bonney osteotomy remains a relevant orthopedic surgery for big toe arthritis, the Bonney myomectomy technique is now primarily of historical importance, though its underlying principles remain vital to gynecological practice. The development of Bonney's blue dye also stands as a testament to his innovative approach to improving surgical outcomes. Anyone encountering the term should be aware of its multiple meanings and the specific context in which it is used. For more information on Victor Bonney's life and work, you can visit his Wikipedia page.
Frequently Asked Questions
Which kind of doctor performs the Bonney procedure for a big toe?
An orthopedic surgeon or a podiatrist specializing in foot and ankle surgery would perform a Kessel-Bonney osteotomy for hallux rigidus.
Is the Bonney myomectomy still performed today?
While the specific Bonney clamp is rarely used, the principles of blood flow control and meticulous surgery he pioneered are integral to modern myomectomies. Today's surgeons use more advanced techniques and instruments but follow similar goals.
What is Bonney's blue?
Bonney's blue is an antiseptic dye used to stain the skin and mucosa before surgery. It was developed by Victor Bonney to define the surgical field and reduce the risk of infection. It is still used today for various purposes.
What are the main differences between the two Bonney procedures?
The main difference is their purpose and location. The Kessel-Bonney osteotomy is a foot surgery for arthritis, while the Bonney myomectomy technique is a gynecological procedure for removing uterine fibroids.
How effective is the Kessel-Bonney procedure for hallux rigidus?
Studies have shown good results for treating mild to moderate hallux rigidus, improving range of motion and reducing pain. However, it may not stop the arthritic process entirely, and sometimes further surgery is needed.
Are there alternatives to the Bonney myomectomy technique for fibroids?
Yes, modern alternatives include other forms of myomectomy (laparoscopic, hysteroscopic), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound (MRgFUS), and radiofrequency ablation.
What is the recovery time for a Kessel-Bonney osteotomy?
Recovery typically involves a period of wearing a protective postoperative boot for several weeks. Swelling and pain are common initially, but most patients can resume comfortable walking within a few weeks to months, with exercises to restore mobility.
