Dr. Jacoby describes Dellon decompression.
The Dellon Decompression–probably the most controversial surgical procedure in medicine today. Lee Dellon, professor of neurosurgery and plastic surgery at Johns Hopkins University Medical School, probably the finest medical school in the world, and he is probably the brightest person in this field.
He developed this procedure. It’s called the triple nerve release, and basically what he came upon in the early 80s and actually in the 70s, it came from a process called the double crush syndrome, and that was a process that two plastic surgeons from Harvard in 1973, two fellows by the name of Upton and McComas, came up with and they were talking about the upper extremity brachial plexus and carpal tunnel.
Carpal tunnel being the most common compressive neuropathy, and they noticed that patients who had carpal tunnel also had brachial plexus, but they also more importantly had diabetes, 16 percent, and they wondered what was the association. They came up with the term double crush.
Lee Dellon out of Johns Hopkins investigated that. He did primates. He did rat studies. He did an interesting study. He made rats diabetic artificially and put them on a piece of paper with ink on their paws and to see if their gate pattern was changed, and it was.
And then he instituted some other studies to see if there was compression causing this, and he took out the tarsal tunnel, which is the same as the carpal tunnel in the wrist. He took out the tunnel to see if they would develop the compression and they didn’t, and he came up with this procedure that is called the Dellon Triple Release.
But he only applied it to the upper extremity, and one of his patients came in one day and said, “Dr. Dellon, you fixed my arm, why don’t you fix my foot?”
He said, “Well, that’s not done.”
Then he thought about it. He said, “Wait a minute, it’s not done; why isn’t it done?” And he came up with this procedure. I trained with him in the year 2001. I drank the Kool-aid the first, and I became enamored by his teachings, by his dedication to this procedure, and I have done over 1500 procedures, not one amputation.
The real dilemma that I have with this procedure is why don’t other doctors understand this disease? Why do they give them medications? Why do they let them go on to amputations? It just doesn’t make sense.
The triple nerve release is really the carpal tunnel of the leg. We have a diagram that will show you where the three tunnels are, and we decompress them. What is a decompression? It basically makes the tunnel where the nerve goes through bigger. We don’t really do anything to the nerve itself, we just make it a larger space so it’s not compressed.
A story that just struck me and made me passionate about this procedure–I worked for a long time and I was one of the co-founders of the Scottsdale Wound Care Center. I worked there for years, and just, not to be crude, but we scraped off a lot of puss. We did a lot of amputations, but we saved a lot of legs too.
But it wasn’t as fulfilling as what I am doing today, and I had a patient early on, and I came back from Dr. Dellon’s course down in Johns Hopkins, and I remember this gal like it was yesterday. And I won’t use her real name, but her first name was Janet; I won’t use her real name, and I said, “Janet.”
She had a twin sister who had just had an amputation. I must have seen her in the hospital every year for ten years. We had this piece of toe taken off, and she had infections. It is the typical sad story. She was in a wheelchair. She was in braces. She didn’t go anywhere. I said, “Janet, you are facing an amputation. Why don’t we try this procedure? I don’t know if it will work, but what do we have to lose?” And she said, “Let’s do it.”
I did the procedure, my very first one, probably the worst patient I could even select to do it on, and it worked. But then I didn’t see her for four months, maybe five months, and I thought, ”I killed her.” I didn’t know what happened to her.
She comes in one day - walking, by the way, without a wheelchair, without braces - and I said, “This is amazing.” I said, “What happened?” She said, “I couldn’t walk, and my husband took me to Hawaii. And I was walking in Hawaii on the lava rocks, and I fell and I broke my arm. I just wanted to come in and thank you.”
About Dr. Jacoby, D.P.M.:
Dr. Richard Jacoby, D.P.M., graduated from the Pennsylvania College of Podiatric Medicine. He completed his residency at Parkview Hospital, Philadelphia, specializing in foot and ankle surgery. Board certified by the American Board of Podiatric Foot and Ankle Surgeons, he is currently president of Valley Foot Surgeons in Scottsdale, Arizona. In addition, Dr. Jacoby is chairman of the board of Healthcare Networks of America.
Dr. Jacoby has been named the 2010 President of The Association of Extremity Nerve Surgeons.