title: New experiences in treating postburn talipes equinovarus associated with bone and joint pathologic changes.
abstract: This article aims to solve the problem of postburn talipes equinovarus associated with bone and joint pathologic changes by simplified and modified techniques. In addition to lengthening the shortened Achilles tendon and the contracted scar above it, we performed triple arthrodesis directly on the densely scarred, deformed foot without replacing the scar tissue with normal tissue tube or flap. Only the proximal scar-periosteum wound edge of the curved incision, 2 cm distal to the conventional one, was elevated to expose the bones to be excised. The two excised wedge-shaped bone blocks, one on the dorsum and the other on the lateral side of the deformed foot, were composed of a larger part of the talus and lesser parts of the navicular, cuboid and calcaneus bones. All the patients who could not stand or walk without crutches pre-operatively obtained a good operative result, which enabled them to do so without crutches postoperatively. We conclude that the scar tissue can be elevated without risk of necrosis if it is still attached firmly to the underlying periosteum, and arthrodesis can be done under it. Incision wound healing and bone union is not exclusively a problem.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, 639 Zhi Zao Ju Road, Shanghai 200011, China.
authors.forename: Tianyi
authors.initials: T
authors.lastname: Liu
authors.forename: Danru
authors.initials: D
authors.lastname: Wang
authors.forename: Yunliang
authors.initials: Y
authors.lastname: Qian
authors.forename: Yaoming
authors.initials: Y
authors.lastname: Shi
authors.forename: Wenxiang
authors.initials: W
authors.lastname: Guan
mesh_terms: D000125:Achilles Tendon / Q000601:surgery; D000328:Adult; D001174:Arthrodesis / Q000379:methods; D002056:Burns / Q000150:complications*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D003286:Contracture / Q000209:etiology / Q000601:surgery; D004863:Equinus Deformity / Q000209:etiology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005529:Foot Bones / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult