Surgical Correction of Popliteal Pterygium with Serial Splinting: A Case Report and Review of Literature

Sewilam, Mohammed; Hassan, Abdelaziz Rizk; Shoaib, Amr; Alrayes, Majd

doi:10.1097/gox.0000000000003913

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…Sensory deficits were also encountered by several reports after performing other techniques of nerve repair mentioned earlier, which flags the importance of possible future complications such as plantar ulcers. 13 , 26 During the early regeneration process after the procedure, fluid permeation from the surrounding tissue was the primary nutrient mode of transport for the graft. Micro-vessels started to grow on both ends of the graft and penetrated the nerve matrix along the long axis.…”

Section: Discussionmentioning

confidence: 99%

“…Sewilam et al proposed a theory of nerve maldevelopment which resulted in short nerve formation and disturbed the normal growth of the surrounding tissue such as the muscles, tendons, and skin folds. 13 This theory might explain the location of the sciatic nerve that superficially bowstrings at the 52 fibrous band's free end. This short nerve remains a major problem in treating popliteal pterygium with severe flexion deformity.…”

Section: Discussionmentioning

confidence: 99%

“…Post-operative serial casting might be applied for better results. 13 However, previous literatures have reported recurrence being commonly observed as patients grow. Therefore, patients with popliteal pterygium should be closely monitored after undergoing treatments and parents should be educated regarding the possibility of repeated surgical corrections to This case report has its own strength and weaknesses.…”

Section: Dovepressmentioning

confidence: 99%

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Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

Hasan¹,

Muhammad²,

Cein³

et al. 2023

ORR

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Introduction Popliteal pterygium syndrome (PPS) is a rare autosomal-dominant condition that causes fixed flexion deformity of the knee. The popliteal webbing and shortening of the surrounding soft tissue could limit the functionality of the affected limb unless it is surgically corrected. We reported a case of PPS in a pediatric patient encountered in our hospital. Case A 10-month-old boy came with a congenital abnormally flexed left knee with bilateral undescended testis and syndactyly of the left foot. The left popliteal pterygium extending from the buttock to the calcaneus was observed, with an associated fixed flexion contracture of the knee and equine position of the ankle. Normal vascular anatomy was seen in the angiographic CT scan; therefore, multiple Z-plasty and fibrotic band excision were performed. The sciatic trunk was exposed on the popliteal level, and the fascicular segment was excised from the distal stump and sutured to the proximal stump under the microscope to extend the sciatic nerve for approximately 7 cm. No postoperative complications were reported. Multiple tendons and soft tissue reconstruction were performed when the patient was 2-year-old to correct the adductus and equine deformity of the left foot. Discussion Surgical correction for popliteal pterygium demands staged techniques to deal with the shortened structure. In our case, multiple Z-plasty were performed, and the fibrotic band was excised until its base with meticulous consideration of the underlying neurovascular bundle. Fascicular shifting technique for sciatic nerve lengthening can be considered in unilateral popliteal pterygium with difficulty extending the knee due to shortened sciatic nerve. The unfavorable outcome of nerve conduction disturbance resulting from the procedure may be multifactorial. Still, the existing foot deformity, including a certain degree of pes equinovarus could be treated by multiple soft tissue reconstructions and adequate rehabilitation to achieve the desired outcome. Conclusion Multiple soft tissue procedures resulted in acceptable functional outcomes. However, the nerve grafting procedure is still a challenging task. Further study is required to explore the technique in optimizing the nerve grafting procedure for popliteal pterygium.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

See 1 more Smart Citation

Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

Hasan¹,

Muhammad²,

Cein³

et al. 2023

ORR

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Comparative analysis of surgical treatment modalities for a popliteal pterygium: a meta-analysis

Aman,

Sidiq,

Pennekamp

et al. 2024

Arch Orthop Trauma Surg

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Popliteal Pterygium Syndrome: A Case Report Highlighting Challenges and Surgical Interventions in a Resource-limited Setting

Shanko,

Eshete,

Hussen

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Popliteal pterygium syndrome is a rare congenital disorder characterized by facial, genitourinary, and musculoskeletal anomalies, with popliteal webbing being notably challenging. A 4-year-old boy presented with progressive limping, cleft palate, and genital malformations. He had no follow-up care after an intraoral band excision at 15 days old. The boy underwent surgery for left-sided popliteal webbing, followed by genital and cleft palate repair. A modified jumping man Z-plasty flap was used for the popliteal webbing, followed by splinting. Subsequent follow-ups showed no complications. Enhancing care in resource-constrained settings requires addressing challenges such as delayed interventions due to late follow-up, limited awareness between communities and healthcare professionals, social stigma, and inadequate healthcare understanding. These obstacles hinder timely diagnosis and intervention, underscoring the need for increased awareness and effective early intervention strategies. Early detection and parental counseling are critical in managing popliteal pterygium syndrome. Timely surgical planning, including addressing orofacial and genital deformities and using Z-plasty for webbing release, is essential. Postoperative splinting significantly improves outcomes.

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Surgical Correction of Popliteal Pterygium with Serial Splinting: A Case Report and Review of Literature

Cited by 4 publications

References 20 publications

Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

Comparative analysis of surgical treatment modalities for a popliteal pterygium: a meta-analysis

Popliteal Pterygium Syndrome: A Case Report Highlighting Challenges and Surgical Interventions in a Resource-limited Setting

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