Extensive Soft Tissue Release Research Articles

The surgical management of resistant club foot by rotation skin flap and extensive soft tissue release.

Resistant club foot remains an unsolved problem because of the complex aetiological and pathological factors, and is still seen quite frequently, especially in developing countries. The posteromedial skin contracture is a potent deforming force which is responsible for many failures or relapses. I report the results of an operation in which a rotation skin flap was combined with an extensive soft-tissue release. The age of the children was from 9 months to 10 years. The follow-up period was from one to 9 years with an average of 43 months, and in 50 cases for more than 5 years. I consider that the outcome has been excellent or good in 94 out of 100 feet.

Soft-tissue release of the hips in children with juvenile chronic arthritis.

In juvenile chronic arthritis the hips are commonly affected and this becomes the most important reason for losing independence and mobility: the joint develops a painful flexion contracture with marked loss of movement. Soft-tissue release operations consisting of psoas and adductor tenotomies have proved a safe and effective method of relieving pain and improving function. We report 89 such operations in 52 patients. More extensive soft-tissue release operations or synovectomy of the hips offer no advantage and recovery is often more painful and prolonged.

Treatment of Painful Long-standing Displaced Fracture-Dislocations of the Sacrum

A 19-year-old white man sustained multiple injuries, including a severely displaced Malgaigne fracture. Secondary uncontrollable hemorrhage was treated successfully by arterial embolization. The patient retained a painfully displaced right sacroiliac joint. His multiple injuries resolved symptom free with the exception of the right sacroiliac region. An attempt to reduce the dislocation by an extensive soft tissue release and skeletal traction was unsuccessful. Solid fusion of the L4 and L5 vertebrae to the ilium significantly reduced the patient's pain. Painful, long-standing severely displaced Malgaigne fracture can be successfully treated by sacroiliac arthrodesis without reduction.

Observations on operative management of neglected club-foot.

The results of surgical treatment of neglected club-foot in patients aged between 8 and 28 years are reported. Extensive soft tissue release together with dorso-lateral wedge resection in patients aged between 8 and 11 years and triple arthrodesis after the age of 11 years gave a high proportion of results that were satisfactory to the patient and the surgeon. Surgical correction of severely deformed and neglected club-feet in adults is advocated to achieve plantigrade, painless and cosmetically acceptable feet.

Avascular necrosis of the body of the talus after combined medial and lateral release of congenital clubfoot.

A retrospective study was made of 203 patients with 321 congenital clubfoot deformities who had at least one operative procedure at the Shriner's Hospital in Greenville, South Carolina, in a period from 1944 to 1973. The five cases of avascular necrosis of the talus occurred among the 35 patients having combined medial and lateral releases. These five clubfeet were recurrent and recalcitrant and required extensive soft tissue release to achieve sustained correction. It is recommended that dissection of the subtalar joint, except at the talonavicular joint, be avoided and that extensive lateral ankle dissection, especially when the sinus tarsi is included, should not be performed simultaneously with the medial release unless absolutely necessary to achieve the desired anatomic relationship.