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Soft-tissue expander failure in severe equinovarus foot deformity
G S Bassett1, K U Mazur, G M Sloan
1Department of Orthopaedics, USC School of Medicine.
Journal of Pediatric Orthopedics
|November 1, 1993
Summary
Soft-tissue expanders show limited success in severe clubfoot surgery, with high complication rates. Complications like ischemia and infection often necessitate premature removal, impacting treatment outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Reconstructive Surgery
Background:
- Soft-tissue expanders are increasingly explored for complex orthopedic conditions.
- Clubfoot (equinovarus foot deformity) can present severe challenges requiring extensive soft-tissue management.
- Previous reports suggest potential benefits of tissue expansion in clubfoot surgery.
Observation:
- This study evaluated the use of soft-tissue expanders in seven severe clubfoot deformities across five patients.
- Patient diagnoses included arthrogryposis, cerebro-oculo-facial syndrome, ischemic contracture, and spina bifida.
- The expanders utilized had self-contained ports, and patients exhibited poor compliance with tight subcutaneous tissues.
Findings:
- A high complication rate (71%) was observed, with five of seven clubfeet requiring premature expander removal due to ischemia, infection, or sepsis.
- Minor complications like partial wound dehiscence occurred in the two successful expansions.
- Factors contributing to complications included expander design, patient compliance, and limited subcutaneous space compromising vascular supply.
Implications:
- The use of soft-tissue expanders in severe clubfoot deformities presents significant risks and challenges.
- Careful patient selection and consideration of expander-related factors are crucial for managing expectations and potential complications.
- Further research is needed to optimize techniques or identify alternative strategies for severe soft-tissue deficiency in clubfoot treatment.