Journal of Clinical & Experimental Orthopaedics

The use of Human Amniotic Membrane for Wound Closure after Clubfoot Release: A Case Series

Introduction: The use of the Ponseti technique continues to be the method of choice for the treatment of bot foot, however, in those patients with recurrence due to poor adherence to treatment, syndronics, etc. medial postero release emerges as an alternative. Several coverage techniques are described in post-release residual defects from muscle or fasciocutaneous flaps, skin-free grafting, or open defects that close by the second intention. In recent years the relevance of the use of Human Amniotic Membrane (hAM) as a substitute for dermal matrix has been described. There are two cases of closure of bilateral post-medial post-release wound defect in the recurrence of bot foot with said membrane. Materials and Methods: Case 1: A 2-year old boy with Moebius syndrome associated with clubfeet was treated with the Ponseti method at birth. At 2 years of age, the deformity recurred in both feet and he was again treated with serial casting and posteromedial release using the Cincinnati incision. After the procedure, complete skin coverage was not possible and the large defect was treated with hAM. Case 2: A 10-year-old girl with arthrogryposis had bilateral clubfoot deformities treated with the Ponseti method at birth. Compliance with Ankle-Foot Orthoses (AFOs) was poor and subsequently, the treatment was abandoned. The posteromedial release was performed using the Cincinnati approach with good correction of the deformity; however, there was a severe soft-tissue defect that was treated with hAM. Case 3: An 8-year-old boy with arthrogryposis and clubfeet. He was treated with the Ponseti method at another institution. He had a severe equinovarus deformity that was corrected with posteromedial release using the Cincinnati approach. Postoperatively, the patient had no residual deformity, but complete skin coverage was not possible, and hAM was used. Results: All patients are currently with complete coverage, without recurrence of primary pathology. Conclusion: The use of amniotic membrane could be an option for the closure of posteromedial post-release defects of bot foot.

Bibiana Dello Russo, Tripodi María Laura, Castellá María Agustina and Guevara Ramiro