Distraction Histogenesis in Ankle Burn Deformities

Saghieh, Saïd; Bitar, Youssef El; Berjawi, Ghina; Harfouche, Bachar; Atiyeh, Bisharah

doi:10.1097/bcr.0b013e31820334c7

Cited by 19 publications

(13 citation statements)

References 31 publications

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“…Barquet et al specially designed an external fixator to gradually and slowly draw the flexion contracture of patients with knee stiffness, which resulted in satisfying effects [21]. Saghieh et al applied Ilizarov external fixation to solve skin ductility difficulty in three cases of burned ankle stiffness patients [22]. There were also reported external fixation and free flap combined applications for severely recurrent flexion joint stiffness [23].…”

Section: Discussionmentioning

confidence: 99%

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

Tang

et al. 2014

Indian J Surg

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The knee release surgery and postoperative rehabilitation of patients after burns and knee straight stiffness were investigated. Eleven patients were treated for 16 side burns and knee stiffness who consisted of nine males and two females, aged 19 to 54 years (mean=33.2). The duration of the patients' knee stiffness ranged from 8 to 26 months, with an average of 12.6 months. Their preoperative flexion ranged from 5°to 50°, with an average of 26.2°. Their preoperative Hospital for Special Surgery (HSS) knee scores ranged from 46 to 72 points, with an average of 55.8 points. All stiff knees were treated with release surgery, along with total release of intra-articular adhesion and excision of vastus intermedius. After the arthrolysis of the stiff knee joint, the tight skin was completely loose in the adhesions. The soft tissue contracture was not grafted, but the shade fascia was freed to increase skin ductility. All knee joints were released to more than 90°of flexion in the operation, and reversed fascia flaps were used to suture the loss of the deep fascia at the position of flexion of 90°. After the operation, the knee joint was fixed in flexion for 72 h while being actively cared for by early rehabilitation. Subsequently, the patient's skin coverage, joint motion, and joint function recovery were observed. Based on the followup of the patients for the following 16 to 36 months (mean= 25.7), the knee flexion of the patients ranged from 110°to 135°, with an average of 122.2°and 96°increase (P<0.01). Furthermore, the patients had better skin ductility to meet the increase in joint flexion. HSS knee function scores at the end of follow-up ranged from 93 to 100 points, with an average of 97.5 points and an increase of 41.7 points (P<0.01). The joint function improved significantly. The arthrolysis of straight stiff knee joints after burns can ease muscle contracture and free the shade fascia, thus avoiding the need to undergo skin grafting. Short-term fixation of the joints after surgery and active flexion rehabilitation may also be the key to improve skin ductility and joint function of the patients.

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Section: Discussionmentioning

confidence: 99%

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

Tang

et al. 2014

Indian J Surg

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“…van Roermund et al [4] observed a decrease in pain and improvement of joint function in 3 patients with ankle joint stiffness. Similarly, Said Saghieh et al [9] described their successful experience in treating severe PAC with Ilizarov technique in 3 patients.…”

Section: Treatment With External Xatormentioning

confidence: 99%

3D Printed Models Improve Surgical Planning for Correction of Severe Postburn Ankle Contracture With External Fixator

Han

Niu

Jiang

et al. 2020

Preprint

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Background: Gradual distraction with external fixators such as Ilizarov frame has been widely used for the treatment of severe postburn ankle contracture (PAC). However, the application of external fixator is complex and conventional surgical planning based on 2D imaging is compromised due to a lack of spatial geometry and tactile feedback. The purpose of this study was to evaluate the surgical planning with patient-specific 3D-printed models (3DPM) for the treatment of PAC with external fixators. Methods: A two-centered retrospective cohort study, composed of consecutive patients who underwent external fixation for the treatment of severe PAC, was implemented. Patients were divided into two cohorts (3DPM group vs. Control group) according to whether 3DPM was used for preoperative surgical planning. The primary outcome variable was operation duration. Other outcome variables included improvement in metatarsal-tibial angle (MTA), range of motion (ROM), American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications. Results: Between January 2008 and June 2018, ten patients with an average age of 23.8±14.1 yeas were treated for PAC at two centers. 3DPM were used for surgical planning in 5 patients. 3DPM group had significantly shorter operation duration than the control group (2±0.3 hours vs. 3.2±0.3 hours, p=0.0001). The comparison of preoperative, after removal of external fixator, and follow-up MTA, ROM, and AOFAS between the 3DPM and control group showed no significant differences. A plantigrade foot was achieved and gait was substantially improved in all patients at the final follow-up. Pin-tract infections occurred in 2 patients (one in each group) during distraction and were treated with wound care and oral antibiotics. Conclusion: The results of this study show that surgical planning using patient-specific 3DPM significantly reduced the operation duration while providing similar improvements in MTA, ROM, and AOFAS scores compared to traditional surgical planning for the correction of severe PAC with external fixators.

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“…3,9,25,26,28,33 Such procedures are associated with a high risk of vascular and soft tissue complications, because deep scarring and retraction involving the posterior-medial neurovascular bundle of the foot and ankle from previous surgeries are common. 3,22,27,33 Arthrodesis with deformity correction usually involves extensive dissection of soft tissue, multiple osteotomies removal of large bone wedges, with increased risk of skin and bone necrosis and/or infection, 10,24,25,27 as well as excessive shortening of the foot and limb, leading to imbalance on the contralateral side. 2,3,5,20,25 Stiff equinovarus deformities (ECDs) of the foot are mostly caused by neglected trauma, 14,29 burns, 19,27 compartment syndrome of the leg, 5,14,16 peripheral nerve injury, 31 and central nervous system lesions.…”

Section: Introductionmentioning

confidence: 99%

“…3,22,27,33 Arthrodesis with deformity correction usually involves extensive dissection of soft tissue, multiple osteotomies removal of large bone wedges, with increased risk of skin and bone necrosis and/or infection, 10,24,25,27 as well as excessive shortening of the foot and limb, leading to imbalance on the contralateral side. 2,3,5,20,25 Stiff equinovarus deformities (ECDs) of the foot are mostly caused by neglected trauma, 14,29 burns, 19,27 compartment syndrome of the leg, 5,14,16 peripheral nerve injury, 31 and central nervous system lesions. 2,23,26,30 These cosmetically challenging and functionally incapacitating deformities are common in developing countries.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, because of the equinus position, these deformities are often associated with chronic metatarsalgia and/or forefoot plantar ulcers, especially in those patients with reduced sensitivity, increasing the risks of infection and amputation. 17,31 This is particularly true in cases where there is scarring, shortening, and adhesions of the posteromedial neurovascular bundle of the foot, such as after severe lower extremity trauma, compartment syndrome, 1,5,[14][15][16] burns, 19,27 previous surgeries, 5,19 late effects of paralytic disease, 9,17,20,24,30,32 and chronic vascular disease. 1,6,25 Poor skin quality/multiple scars, joint stiffness secondary to arthrofibrosis, shortening of the foot, claw toes, and neglected or mistreated childhood osteoarticular deformities can further complicate efforts to achieve a plantigrade foot.…”

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive Surgery Using the Circular External Fixator to Correct Neglected Severe Stiff Equinocavus Foot Deformities

Costa

Lotti

Pistorello

2018

Foot & Ankle Orthopaedics

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Background: Stiff equinocavus deformities of the foot are challenging to treat, often requiring extensive soft tissue dissection and bone removal. These procedures frequently yield suboptimal results and not infrequently amputation. Minimally invasive surgery using a circular external fixator potentially avoids the trauma to the soft tissue and may lead to improvement in outcomes and a lower amputation rate. The objective of this study was to evaluate the efficacy of minimally invasive surgery using a circular external fixator and limited soft tissue release to correct stiff equinocavus deformities. Methods: The treatment outcome of 29 patients (31 feet) with stiff equinocavus deformities of the foot and ankle treated with minimally invasive surgery and circular external fixation were reviewed after a mean follow-up period of 63 months. Patients' demographics and cause of the deformities were recorded. Weight bearing radiographs of the foot were compared pre and postoperatively. Results: Outcome was satisfactory (plantigrade foot with improvement/resolution of pain) in 21 of 31 extremities, fair in 6 of 31 extremities, and poor in 4 of 31 extremities. In the majority of patients, a significant improvement in the equinocavus deformities was achieved with a statistically significant improvement in calcaneus and navicular height. Two patients with Charcot-Marie-Tooth and severely insensate feet had a poor outcome, resulting in transtibial amputation. Conclusion: Minimally invasive surgery with gradual correction of neglected stiff equinocavus deformities using a modular circular external fixator is a reliable initial limb salvage strategy. Minimally invasive surgery and gradual correction of neglected severe stiff equinocavus deformities using the modular circular external fixator to gradually correct neglected severe stiff equinocavus deformities, is a safe initial limb salvage strategy which may simplify secondary procedures such as arthrodesis. Level of evidence: IV.

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Distraction Histogenesis in Ankle Burn Deformities

Cited by 19 publications

References 31 publications

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

3D Printed Models Improve Surgical Planning for Correction of Severe Postburn Ankle Contracture With External Fixator

Minimally Invasive Surgery Using the Circular External Fixator to Correct Neglected Severe Stiff Equinocavus Foot Deformities

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