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COMPARISON OF TWO SURGICAL APPROACHES IN CLUBFOOT: SINGLE POSTEROMEDIAL RELEASE VERSUS COMBINED POSTEROMEDIAL AND LATERAL RELEASES

Authors: Alaa Abdulemmam Barrak --- Ouday Falih Al-Ali
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 2 Pages: 38-45
Publisher: Basrah University جامعة البصرة

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Abstract

This comparative prospective study was conducted to assess surgical outcome and postoperativecomplications in 70 children with 115 idiopathic clubfeet treated at Basrah GeneralHospital. Children up to age of 5 years were included. There were 49 males and 21 females.Male to female ratio was 2.3:1. The deformity was bilateral in 61.4% and unilateral in 38.6% ofcases. The indications for surgery were failure of early conservative treatment and late patientpresentation beyond 6 months of age. Patients were placed into two groups; group A in whom astandard posteromedial soft tissue release through single incision including 58 feet (19moderate, 28 severe, and 11 very severe), whereas in group B, combined posteromedial andlateral releases through two separate incisions in 57 feet (19 moderate, 28 severe, and 10 verysevere). Analysis of data reveals that combined release is superior to single release in the ratesof operative wound breakdown and more important in term of correction of initial preoperativeclubfoot deformity for which the surgery was performed. Postoperative skin necrosis occurred in8.8% of combined release feet compared to 17.2% in single posteromedial release feet. Withcombined release 87.7% of feet obtained satisfactory deformity correction outcome in contrastto only 63.8% in single release feet. The most common single residual deformity reported in thisstudy following surgical correction whether by single posteromedial release (13.8%) or bycombined release (12.3%) was forefoot adduction. The risk of wound infection wasapproximately the same for both procedures 8.6% in single release, and 8.8% in combinedrelease.The study showed that the proportion of satisfactory deformity correction results decreases asthe patient age at operation increases, particularly if single posteromedial release alone wasperformed. With single release a 100% satisfactory deformity correction outcome will beobtained only if surgery was performed during the first 6 months of life, beyond which this ratehad dropped to 63.6% when operation was delayed to the age of 7-12 months, and to 25% at1-3 years of age. After 3 years of age single posteromedial release alone did not yield anysatisfactory results. On the other hand a100% satisfactory results were obtained in all feettreated with combined release during the whole period of the first 3 years of life, after which therate of satisfactory results decreased to 50%. The study highly recommends the use ofcombined posteromedial and lateral release through two separate incisions when operating onclubfeet above the age of 6 months. This is a very valuable procedure with high success rateboth in correcting the initial deformity and minimizing the rates of surgical wound breakdown.

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