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Abstract

Skin necrosis and wound problems complicate surgical release of severe neglected clubfoot. This is primarily the result of excessive tension on the skin edges and a poor understanding of the abnormal vascular anatomy in clubfoot. We report a technique of primary skin closure by using a local-rotation fasciocutaneous flap. Posteromedial skin incision is taken. Posterior tibial artery perforators supplying the medial flap and saphenous vein are preserved. After soft-tissue release and correction of deformity, a defect appears in the posteromedial part of wound. Horizontal backcut is taken at proximal part of the incision and entire medial fasciocutaneous flap is rotated inferiorly to cover the defect. Triangular defect appearing proximally is sutured primarily or covered with skin graft. Primary uncomplicated wound healing was achieved within 2 weeks in all 20 rigid and neglected clubfeet (1-7 years) operated on with this technique. This flap is scientifically logical, technically easy, and ensures primary wound healing.

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

“…7,11,22–28 The procedure achieves correction by creating laxity in the hindfoot, allowing it to roll out of equinus and varus, and positioning the calcaneus within the ankle mortise for a stable neojoint. 9,22,23,28 Talectomies, though, do not adequately addressed the forefoot deformity. 26,28 Spontaneous calcaneotibial arthrodeses occur, which may lead to rigid foot positioning, often in equinus, point loading on skin and decubiti formation.…”

“…26,28 Spontaneous calcaneotibial arthrodeses occur, which may lead to rigid foot positioning, often in equinus, point loading on skin and decubiti formation. 23,25,29–31 The literature presents a complex and fragmented picture, as most studies group primary and salvage talectomy procedures together. Cassis and Capdevila 22 described results in 16 primary and 85 salvage talectomies done at an average age of 4.3 years, with mean follow-up of six years.…”

“…11,30 Larger series report the satisfactory rate of primary talectomies as only 45% to 50%. 7,15,23,24…”