Rattan L Mittal1,2. 1. Mittal Ortho Centre, 97, New Lal Bagh Colony, Patiala, Punjab, 147001, India. mittalrl@yahoo.co.in. 2. Formerly:- Professor and Head Department of Orthopaedics/ Principal Government Medical College, Medical Superintendent Rajendra Hospital, Patiala, Punjab, 147001, India. mittalrl@yahoo.co.in.
Abstract
AIM/ PURPOSE: Extreme congenital club foot deformities are common in developing countries, presenting at birth, persisting in children, adolescents and adults; as untreated/under-corrected by conservative and/or surgical means. Scores of confusing names exist in literature for such deformities with no good treatment available; mostly advocating unacceptable arthrodesis. The author researched this grey area for more than 40 years and successfully innovated improved surgical corrections, more acceptable to patients. METHODS: All were given a generic name: "extreme deformities", with 3 hierarchic grades. each 3D (trimorphic) because of their common aim: a good correction. The author started with anatomical dissections in clubfeet (zero cost), consistently reinforced with solid clinical background. Heterogeneous skin contractures, congenital with/without scars, were discovered as the primary cause with cramped deeper tissues and evolved, evidence based, 3D enlargement of skin chamber by triple expanding incisions: DOrso-LAteral Rotation skin flap (DOLAR- acronym) for grade I, DOLAR + Z-plasty (DOLARZ) for grade II and DOLAR + Z + VY-plasty (DOLARZ-E) for grade III, E means Extended. Patient satisfaction level (excellent, good, fair/poor) had been considered for grading results, rather than scoring systems because each clubfoot is different with countless variables. RESULTS & CONCLUSIONS: The author operated 1080 feet during the last 40 years with long term follow up, six months to 30 years, with an average of 12½ years. The results obtained were: excellent/good (96%) and fair/poor (4% including superficial skin necrosis only in 3%, evidence based). Triple surgical skin expansion consistently resulted in longer, flexible, joints sparing, good shaped, better functioning foot; even in adults.
AIM/ PURPOSE: Extreme congenital club foot deformities are common in developing countries, presenting at birth, persisting in children, adolescents and adults; as untreated/under-corrected by conservative and/or surgical means. Scores of confusing names exist in literature for such deformities with no good treatment available; mostly advocating unacceptable arthrodesis. The author researched this grey area for more than 40 years and successfully innovated improved surgical corrections, more acceptable to patients. METHODS: All were given a generic name: "extreme deformities", with 3 hierarchic grades. each 3D (trimorphic) because of their common aim: a good correction. The author started with anatomical dissections in clubfeet (zero cost), consistently reinforced with solid clinical background. Heterogeneous skin contractures, congenital with/without scars, were discovered as the primary cause with cramped deeper tissues and evolved, evidence based, 3D enlargement of skin chamber by triple expanding incisions: DOrso-LAteral Rotation skin flap (DOLAR- acronym) for grade I, DOLAR + Z-plasty (DOLARZ) for grade II and DOLAR + Z + VY-plasty (DOLARZ-E) for grade III, E means Extended. Patient satisfaction level (excellent, good, fair/poor) had been considered for grading results, rather than scoring systems because each clubfoot is different with countless variables. RESULTS & CONCLUSIONS: The author operated 1080 feet during the last 40 years with long term follow up, six months to 30 years, with an average of 12½ years. The results obtained were: excellent/good (96%) and fair/poor (4% including superficial skin necrosis only in 3%, evidence based). Triple surgical skin expansion consistently resulted in longer, flexible, joints sparing, good shaped, better functioning foot; even in adults.