Use of a Soft Tissue Expander Before Surgical Treatment of Clubfoot in Children and Adolescents

Abstract

Primary closure of the skin after surgical correction of severe clubfoot is difficult, sometimes impossible. The authors describe a surgical technique with the use of a soft tissue expander prior to surgical treatment on clubfoot in children and adolescents. They operated on 13 feet (10 patients) with rigid clubfoot, with ages ranging from 3 to 16 years (average 10 years). Satisfactory skin healing with primary closure of the skin was obtained in 10 feet; the remaining 3 had complications such as infection, skin necrosis, and premature exposure of the expander. The authors conclude that soft tissue expansion before surgical correction of clubfoot in selected cases is a good alternative for the management of skin closure. Special attention should be given to surgical technique.

Technical details of using sural flap in pes equinovarus surgery: a preliminary report on the technique

“…The main disadvantage of this method is the extrusion risk of the expander during tissue expansion in this region. Rosselli et al [9] reported major complications such as infection and Xap necrosis in 3 of 13 extremities with PEV treated with tissue expanders. Roposch et al [10] noted a major complication in 2 of 13 feet subjected to tissue expanders.…”

“…A leading technique is closure of the defect with the assistance of tissue expanders [9,10]. The main disadvantage of this method is the extrusion risk of the expander during tissue expansion in this region.…”

“…However, in cases where problems associated with skin closure are avoided, posteromedial release may also be considered as a single-step treatment alternative in severe cases. Local Xaps [2][3][4][5][6][7][8]22], cross Xaps [11], or expanded Xaps [9,10] are used to close skin defects in this region. Rotation Xaps harvested from the leg may be used for closure of skin defects due to PEV [2][3][4][5].…”

“…In the majority of cases, it is successfully treated with serial castings using the Ponseti method [1]. For neglected patients with no previous conservative treatment, complex surgical procedures may be required for correction of this deformity [2][3][4][5][6][7][8][9][10][11]. The main complication of neglected PEV cases is recurrence of the anomaly.…”

A Prospective Study of Surgical Correction of Ctev by Cincinnati Approach

“…Among them 7 feet had mild patchy necrosis, 3 feet had moderate necrosis and one foot had extensive skin necrosis, wound dehiscence and deep infection. 16 In a retrospective study by Hsu, Wellington K et al, of 217 patients who underwent primary PMR using modified Turco or Cincinnati incision, a significantly low incidence of wound complication is seen in Cincinnati incision than Turcos incision. (6.9% vs 19.6%).…”