Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

Leonchuk, S.S.; Щурова, Е. Н.; Popkov, Dmitry; Chibirov, G.M.; Бидямшин, Р Р; Gatamov, O.I.

doi:10.21823/2311-2905-2018-24-4-32-43

Cited by 3 publications

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“…Известно, одной из особенностей анатомического строения стопы является плотная сопряженность мяг котканных и костных структур; несомненно, при одно моментной коррекции многокомпонентных деформа ций возможен риск нарушения трофики мягких тканей. В 4-6,7 % случаев развиваются негативные изменения в мягких тканях в области оперативного вмешатель ства, в том числе вялая грануляция после операционной раны стопы [4,5]. Роль сосудистого фактора (изменение локального кровоснабжения тканей) в этом процессе остается недостаточно освещенной [5].…”

Section: результаты исследования и их обсуждениеunclassified

“…В 4-6,7 % случаев развиваются негативные изменения в мягких тканях в области оперативного вмешатель ства, в том числе вялая грануляция после операционной раны стопы [4,5]. Роль сосудистого фактора (изменение локального кровоснабжения тканей) в этом процессе остается недостаточно освещенной [5].…”

Section: результаты исследования и их обсуждениеunclassified

“…Однако следует подчеркнуть, что при одномоментной коррекции многокомпонентных деформаций стоп может возникнуть риск наруше ния трофики мягких тканей. В 4-6,7 % случаев раз виваются негативные изменения в мягких тканях в области оперативного вмешательства, в том числе вялая грануляция послеоперационной раны стопы [4,5]. Какую роль в этом процессе может играть со судистый фактор (изменение локального кровоснаб жения мягких тканей)?…”

Section: Introductionunclassified

“…Какую роль в этом процессе может играть со судистый фактор (изменение локального кровоснаб жения мягких тканей)? Однако в литературе данному вопросу посвящены единичные сообщения [5]. Поэтому возникает необходимость тщательного анализа кровоснабжения мягкотканных структур в области оперативного вмешательства при коррекции сложных деформаций стоп.…”

Section: Introductionunclassified

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Study of soft tissue microcirculation in surgical intervention zone before and after single-stage correction of feet multicomponent deformities in patients with cerebral palsy

Щурова

Leonchuk

Popkov

2019

Regional blood circulation and microcirculation

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Introduction. Simultaneous correction of severe deformities of the feet may be accompanied by a negative effect on the trophism of the adjacent soft tissues. However, the literature does not pay enough attention to the analysis of the blood supply to soft-tissue structures in the field of surgical intervention in the correction of complex deformities of the feet. The aim of the study is to investigate condition of soft tissues blood supply in the area of surgery before and after simultaneous correction of severe feet deformities by triple arthrodesis in patients with cerebral palsy.Material and methods. The article is based on the results of study of 21 cerebral palsy patients with multicomponent feet deformities. All patients underwent simultaneous correction of foot deformities with usage of internal fixation. Patients were examined for the soft tissues blood supply (skin, subcutaneous fat, muscles) in the area of surgery using laser and high-frequency Doppler flowmetry before and after performing all phases of foot surgery.Results. Capillary skin blood flow after performing all stages of operation, removing tourniquet and suturing tended to increase in all areas of measurement, but significantly increased on the dorsum of the foot, at points 1 (by 53.3 %, p <0.05), 4 (by 69.0 %, p<0.05), and at point 6 (53.9 %, p <0.05). Indicators of blood flow of subcutaneous fat and muscle tissue after performing all stages of operation and removal of tourniquet did not significantly differ from the preoperative level. In the long-term follow-up period, all examined patients showed good clinical results in 81 % of cases, satisfactory – in 19 % of patients who noted periodic moderate pain in the feet after a long walk. There were no unsatisfactory results.Conclusion. After simultaneous intraoperative correction of severe feet deformities by triple arthrodesis in the area of operative wound in patients with cerebral palsy, there is no decrease in the microcirculatory blood flow in soft tissuesin the surgical intervention area. There is either stabilization or an increase in the perfusion of these structures.

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Section: результаты исследования и их обсуждениеunclassified

Section: Introductionunclassified

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Study of soft tissue microcirculation in surgical intervention zone before and after single-stage correction of feet multicomponent deformities in patients with cerebral palsy

Щурова

Leonchuk

Popkov

2019

Regional blood circulation and microcirculation

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A Surgical Correction of the Tendon - Muscular Apparatus in Equino-Flat-Valgus Feet in Children With Cerebral Palsy

Zubkov

Zherdev

Chelpachenko

et al. 2020

Russian Journal of Pediatric Surgery

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Purpose. to analyze the effectiveness of soft tissue surgical correction of equine-flat-valgus-feet deformity in children with cerebral palsy. Material and methods. A retrospective analysis of clinical and X-ray findings of 47 patients (86 feet) with equino-flat-valgus deformity was performed. All patients were treated surgically. They were divided into two groups by age: Group I - 23 children (4-7 y.o.); Group II - 24 children (8-11 y.o.). The neurological status was examined in patients with the motor development of level I - III (by GMFCS classification) who had hemiparesis, diplegia and tetroparesis. A comparative analysis was made with a reference group which consisted of 30 children (56 feet), aged 4-11, who had exostotic chondrodysplasia or trauma of the ligamentous apparatus in one foot without neurological pathology and feet deformities. Results. One year after surgery, a significant improvement in clinical and radiological parameters comparing to preoperative findings was registered in patients of both studied groups. Most parameters were close to the established reference intervals. In Group I, three years later at the follow-up examination no significant difference was revealed in similar parameters obtained three years later and one year later after the surgery. However, in Group II three years later a negative dynamics was seen in most of studied parameters when compared with reference values and with results of the first postoperative year. Such outcomes demonstrate high efficiency of soft foot tissue surgery in children under 8. A significant decrease in clinical and radiological parameters after similar amount of surgical correction in children of primary school age (8-11 y.o.), which were under the long-term observation, may indicate the ineffectiveness of such techniques at this age. Evaluation of the functional status by the Gillette functional assessment scale three years after the surgery revealed the increased functional status in 78.26% of patients from Group I and in 41.66% from Group II. In some children from Group II (primary school age), there was a negative dynamics in their functional status. Conclusion. In generally, the obtained data indicate good prospects for improving the functional status in the postoperative period in children of both groups. However, the existing negative dynamics in children from Group II (8-11 y.o.) indicates a weak prospective for a long-term surgical deformity correction of the foot ligamentous apparatus because the coming period is a period of rapid growth and increased loading on the musculoskeletal system of a child with cerebral palsy.

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Rational selection of treatment methods in recurrent clubfoot

Дивович

2021

jour

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Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumﬂex joints and without damage to the ﬂexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

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Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

Cited by 3 publications

References 33 publications

Study of soft tissue microcirculation in surgical intervention zone before and after single-stage correction of feet multicomponent deformities in patients with cerebral palsy

Study of soft tissue microcirculation in surgical intervention zone before and after single-stage correction of feet multicomponent deformities in patients with cerebral palsy

A Surgical Correction of the Tendon - Muscular Apparatus in Equino-Flat-Valgus Feet in Children With Cerebral Palsy

Rational selection of treatment methods in recurrent clubfoot

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