Treatment of Posttraumatic Equinus Deformity and Concomitant Soft Tissue Defects of the Heel

Shu, Hengsheng; Ma, Ben; Kan, Shilian; Hongchuan, Wang; Shao, Huanjie; Watson, John T.

doi:10.1097/ta.0b013e3182396320

Cited by 10 publications

(21 citation statements)

References 26 publications

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“…However, the drawbacks of this technique including long operation time, donor site morbidity, and high technical requirement should not be ignored. Also, distraction osteogenesis beneath a free ap would compromise the vascularized tissue [13,14]. Therefore, instead of a free ap, we performed perforator artery pedicled neurotrophic ap, which is simpler and more e cient, for covering massive soft tissue defects.…”

Section: Discussionmentioning

confidence: 99%

The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique.

Wu¹,

Zhang

Zhang³

et al. 2020

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Background The aim of this research is to present our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method. Methods Between 2008 and 2016, soft tissue coverage with pedicled neurotrophic flap followed by distraction osteogenesis using Ilizarov external fixator was performed in 25 patients for reconstruction of segmental bone defects of lower extremity complicated by massive loss of soft tissue. There were 16 men and 9 women: their mean age was 39 years (23 to 57)at the time of surgery. The soft tissue defect after radical debridement ranged from 5 × 9 cm2 to 11 × 14 cm2, and the average size of segmental defect was 5.02 (2.5 to 7.5) cm. Results The distally based sural neurovascular flap was performed in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.74 (4.5 to 9.5) cm. The function was judged to be excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in 7 patients. Complications observed in the process of the treatment included pain, pin tract infections (PTI), ankle midfoot joints stiffness, and nonunion of docking sites. All the cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection. Conclusions The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis should be considered to be an effective alternative approach in the salvage treatment of the massively traumatized and chronically infected lower extremity.

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Section: Discussionmentioning

confidence: 99%

The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique.

Wu¹,

Zhang

Zhang³

et al. 2020

Preprint

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“…In most previous studies on the treatment of equinus deformities, an Ilizarov external fixator was applied in combination with various open procedures. Therefore, it has been difficult to assess how much correction can be achieved with an Ilizarov external fixator alone (11,(24)(25)(26)(27). To our knowledge, only 4 studies have been published on this subject.…”

Section: Discussionmentioning

confidence: 99%

“…In such cases, an Ilizarov external fixator with the concept of distraction histogenesis has been used as a less-invasive attempt to correct equinus deformities (19)(20)(21)(22)(23). Most of the existing studies have reported the use of an Ilizarov external fixator combined with open procedures such as soft tissue release (11,(24)(25)(26)(27). Experience with correction of equinus deformities using an Ilizarov external fixator alone without adjunctive soft tissue procedures is limited.…”

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confidence: 99%

Use of Ilizarov External Fixation Without Soft Tissue Release to Correct Severe, Rigid Equinus Deformity

Jeong

Kim

Song

2015

The Journal of Foot and Ankle Surgery

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“…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%

“…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. 1,2,3,5,[10][11][12][13]18,19,22,[23][24][25][26]28,29 Gradual and progressive correction of these severe deformities, using the distraction-osteogenesis principle proposed by Ilizarov 21 delivered through an external circular fixator, is a less invasive, yet highly effective, alternative in such cases. 5,12,13,15 According to Ilizarov, both soft tissue and bone can grow in response to gradual progressive controlled distraction force.…”

Section: Introductionmentioning

confidence: 99%

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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Treatment of Posttraumatic Equinus Deformity and Concomitant Soft Tissue Defects of the Heel

Abstract: This study showed that posttraumatic equinus deformity accompanied by soft tissue defect of the heel can be treated effectively with Achilles tendon lengthening, reversed sural fasciocutaneous island flap transfer, and a hinged Ilizarov technique.

Cited by 10 publications

References 26 publications

The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique.

The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique.

Use of Ilizarov External Fixation Without Soft Tissue Release to Correct Severe, Rigid Equinus Deformity

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

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