Department of Orthopedics Surgery, Department of Plastic & Reconstructive Surgery, Jordan University Hospital, Amman, Jordan.
Foot Ankle Surg. 2010 Mar;16(1):38-44. doi: 10.1016/j.fas.2009.05.002. Epub 2009 Jun 6.
Neglected idiopathic clubfoot deformities, and severe recurrent deformity after previous surgery presents technical difficulties for correction and challenges for surgeons to achieve primary skin closure.
Between 2000 and 2006, 18 children (30 feet), had complete subtalar release (CSTR) for failed previous surgery in 28 feet and severe neglected congenital talipes equinovarus (CTEV) in 2 feet followed by cross leg fasciocutaneous flaps for reconstruction of residual defect at the ankle and foot after full correction of the deformity. Mean patients followed up were 4.5 years (average 2-8 years). 23 feet were classified as Dimeglio III and 7 feet as Dimeglio IV.
All cases achieved a plantigrade foot, better walking ability (p<0.03), and parental satisfaction with the result (p<0.001). Ankle joint doriflexion increased from mean (-21.33 degrees ) preoperatively to (12.5 degrees ) postoperatively. All cases showed postoperative improvement in their radiographic findings. The mean preoperative talocalcaneal angle increased from (15.7 degrees to 30.03 degrees ). The talo-first metararsal angle improved from a preoperative mean of -16 degrees mean of 5.53 degrees postoperatively. At the final follow-up cosmetically acceptable plantigrade foot was achieved in all feet. Four legs (14.28%) developed hypertrophic scars at the donar flap site. One patient developed 1.5cm marginal necrosis of the flap, which did heal after debridement by secondary intention. None of the feet had recurrence at the final follow up. Despite the enormous improvement clinically and radiologically, their was no statistical significant difference between preoperative and postoperative radiological angles (p<0.069). The number of previous surgical interventions had no influence on the outcome. All the previously treated feet had inadequate release of important tethered soft tissue.
This is indicative of the enormous value of complete subtalar release combined with cross leg fasciocutaneous flap without the need for bony intervention in previously operated failed feet or neglected deformities.
先前手术失败导致的未治疗特发性马蹄内翻足畸形和严重复发性畸形，给矫形带来了技术困难，也给外科医生实现一期皮肤闭合带来了挑战。
2000 年至 2006 年间，18 例儿童（30 足）因先前手术失败（28 足）和严重未治疗先天性马蹄内翻足（2 足）接受完全距下松解（CSTR），随后行交叉腿筋膜皮瓣修复畸形完全矫正后踝关节和足部的残余缺损。平均随访 4.5 年（平均 2-8 年）。23 足为 Dimeglio III 型，7 足为 Dimeglio IV 型。
所有病例均获得了足底负重足，行走能力更好（p<0.03），家长对结果满意度高（p<0.001）。踝关节背屈从术前平均（-21.33°）增加到术后（12.5°）。所有病例术后影像学表现均有改善。术前跟距角从平均（15.7°）增加到术后（30.03°）。跟骰第一跖骨角从术前平均（-16°）改善至术后平均（5.53°）。末次随访时，所有足均获得可接受的美容性足底负重足。4 条腿（14.28%）供区皮瓣处出现肥厚性瘢痕。1 例患者皮瓣边缘 1.5cm 坏死，经二期清创后愈合。末次随访时无足复发。尽管临床和影像学有显著改善，但术前和术后影像学角度无统计学差异（p<0.069）。先前手术次数对结果无影响。所有先前治疗的足均存在重要的被束缚的软组织松解不足。
这表明完全距下松解联合交叉腿筋膜皮瓣在先前手术失败或未治疗的畸形足中具有巨大价值，无需进行骨干预。
