Trimorphic extreme clubfoot deformities and their management by triple surgical skin expanders- DOLAR, DOLARZ and DOLARZ-E (evidence based mega-corrections without arthrodesis)

Abstract

Aim/purpose Extreme congenital club foot deformities are common in developing countries, presenting at birth, persisting in children, adolescents and adults; as untreated/under-corrected by conservative and/or surgical means. Scores of confusing names exist in literature for such deformities with no good treatment available; mostly advocating unacceptable arthrodesis. The author researched this grey area for more than 40 years and successfully innovated improved surgical corrections, more acceptable to patients. Methods All were given a generic name: Bextreme deformities^, with 3 hierarchic grades. each 3D (trimorphic) because of their common aim: a good correction. The author started with anatomical dissections in clubfeet (zero cost), consistently reinforced with solid clinical background. Heterogeneous skin contractures, congenital with/without scars, were discovered as the primary cause with cramped deeper tissues and evolved, evidence based, 3D enlargement of skin chamber by triple expanding incisions: DOrso-LAteral Rotation skin flap (DOLAR-acronym) for grade I, DOLAR + Z-plasty (DOLARZ) for grade II and DOLAR + Z + VY-plasty (DOLARZ-E) for grade III, E means Extended. Patient satisfaction level (excellent, good, fair/poor) had been considered for grading results, rather than scoring systems because each clubfoot is different with countless variables. Results & conclusions The author operated 1080 feet during the last 40 years with long term follow up, six months to 30 years, with an average of 12½ years. The results obtained were: excellent/good (96%) and fair/poor (4% including superficial skin necrosis only in 3%, evidence based). Triple surgical skin expansion consistently resulted in longer, flexible, joints sparing, good shaped, better functioning foot; even in adults.

Octopus Clubfoot Rediscovered - World’s First Exotic Case - A Neglected, Triple Axes Rotational, Grade 3 Extreme Deformity: Corrected by, Unparalleled, 4-In-1 Mega Surgical Skin Expansion from Crooked to ROZY Foot

“…Author has been researching in this grey area of Trimorphic Extreme Clubfoot Deformities since more than 50 years. This nomenclature was given by the author Mittal [1] for 3 grades of this deformity, which are prevalent, worldwide, in all LMICs and 80% of global population. They form a big chunk of the whole, remaining uncorrected, under-corrected or relapsing with age to the tune of 95% Tarraf [2] as reported in literature under various names, for want of a good/ acceptable surgical treatment They are commonly seen in LMICs with millions of DALYs wasted & GBD Ponseti [3].…”