Post clubfoot release skin necrosis: a preventable disaster

Abstract

Complications of pedal wounds closed primarily after release of neglected cases of club foot are well known in literature. We treated a 12-year-old boy presenting with widespread necrosis involving medial aspect of foot after release of neglected talipes equinovarus. Such widespread necrosis is even known to end up in amputations and permanent disabilities. In our case, the foot was successfully salvaged by resorting to dedicated wound care, multiple debridements, use of topical negative pressure (vacuum-assisted closure - VAC), and skin grafting. Various means to prevent such adverse events are also presented. The aim of publishing this case is to stress the need to:

1. Take proper measures preoperatively in neglected club feet to decrease the impact of deformity.

2. To be aware of various different flaps and methods of closure as mentioned in literature and to reaffirm the fact that primary closures done under tension are bound to fail and end up in disasters. 3. To be patient and use the modern concepts of wound management like topical negative pressure if such unfortunate complications do occur and thereby attempt to salvage the feet.

Keywords: club foot complications; necrosis; topical negative pressure; vacuum-assisted closure (VAC); flaps

(Published: 20 April 2011)

Citation: Libyan J Med 2011, 6: 6415 - DOI: 10.3402/ljm.v6i0.6415