A mini-open technique for Achilles tenotomy in infants with clubfoot

Abstract

PurposeA tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR).MethodsThe current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015.ResultsForty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5–48 weeks). The average weight at the time of surgery was 7.3 kg (range 3.6–13 kg). No child had a delay in discharge or stayed overnight in the hospital. No anesthesia-related complications or neurovascular injuries occurred. No child needed a repeat TAL due to an incomplete tenotomy.ConclusionsIn conclusion, mini-open TAL performed in the OR is safe and effective in infants with clubfeet. No complications occurred and all patients were discharged on the day of surgery. Direct visualization of the Achilles tendon via a mini-open technique minimizes the risk of neurovascular injury and incomplete tenotomy.

Percutaneous achillotomy in the treatment of congenital clubfoot: should it be performed in the operating theater or the polyclinic?

“…Achillotomy in patients with clubfoot is generally made percutaneously because it results in minimal fibrosis and scar formation. Some surgeons prefer to perform achillotomies under general anesthesia with a mini-incision to visualize the Achilles tendon, with the aim of protecting vessels and nerves from injury that can occur during percutaneous achillotomy and to avoid incomplete achillotomy [ 18 ]. Nevertheless, the procedure is generally performed as a percutaneous achillotomy under general or local anesthesia [ 19 – 21 ].…”

“…Authors who prefer general anesthesia have reported that they feel safer and more in control of the procedure. It has been emphasized that as a result of the procedure being performed with general anesthesia in operating room conditions, incomplete achillotomy can be avoided, and there is less formation of rigid equinus and rocker bottom deformities [ 18 – 20 ]. In studies where the procedure was performed with local anesthesia, low rates of incomplete achillotomy and associated recurrence and deformity have been reported [ 23 ].…”

Doğuştan çarpık ayak (pes equino varus)

“…MacNeille ve ark. [43] yaptıkları bir geriye dönük çalışmada, ameliyathanede kısa süreli genel anestezi altında uygulamakta oldukları mini-açık Aşil tenotomi yönteminin etkili ve güvenilir olduğunu göstermişlerdir. Mini-açık teknikle yapılan Aşil tenotomisinde nörovasküler yaralanma ve inkomplet tenotomi riskinin en aza indiğini bildirmişlerdir.…”

What is new in idiopathic clubfoot?

“…MacNeille et al recently shared the results of their series of 41 patients where Achilles tenotomy was performed in the operating room with a mini-open technique. All patients were discharged home the same day; none experienced adverse effects of anesthesia or complications from the procedure [21]. Authors purport that doing the procedure in the operating room provides advantages of direct tendon visualization, while minimizing the risk of incomplete tenotomy and neurovascular injury.…”