ABSTRACT
Soft-tissue expanders have recently been reported to be useful in clubfoot surgery. We report our experience with this procedure in five patients with seven severe equinovarus foot deformities. The primary diagnoses of these patients included distal arthrogryposis, cerebro-oculo-facial syndrome, ischemic contracture and spina bifida. Our patients' major complications included ischemia, infection, and sepsis, which resulted in premature removal of the soft-tissue expanders in five of seven clubfeet. Minor complications, such as partial wound dehiscence, occurred in the two successful expansions. Predisposing factors may include soft-tissue expanders with self-contained ports, poor compliance, and extremely tight tissues that limit the subcutaneous space available for expansion, with resultant diminution of the vascular supply to the overlying skin.
Subject(s)
Clubfoot/surgery , Tissue Expansion Devices/adverse effects , Arthrogryposis/complications , Child, Preschool , Clubfoot/etiology , Female , Humans , Infant , Infections/etiology , Ischemia/etiology , Male , Sepsis/etiology , Spina Bifida Occulta/complications , Spinal Dysraphism/complicationsABSTRACT
The incidence of heterotopic ossification after total hip replacement using the direct lateral approach is compared to the incidence using the transtrochanteric approach. All the initial ectopic ossification occurred by six months following the implant with noncemented fixation. The direct lateral approach adds slightly to the incidence of ectopic ossification as compared to the transtrochanteric approach. Heterotopic ossification of minimal grade did not interfere with any of the planar motions of the hip, whereas severe ectopic ossification disabled the hip in several planes of motion and restricted it significantly in the others. The more severe form of ectopic bone was more common after the transtrochanteric approach to the hip, while the lighter form developed more often following the direct lateral approach.
