Staged correction of an equinovarus deformity due to pyoderma gangrenosum using a Taylor spatial frame and tibiotalar calcaneal fusion with an intramedullary device
Jaime L. Bellamy, Courtney A. Holland, Mark Hsiao, Joseph R. Hsu, STReC (Skeletal Trauma Research Consortium)
Keywords :
Pyoderma gangrenosum, Equinovarus, Staged fusion, Taylor spatial frame
Citation Information :
Bellamy JL, Holland CA, Hsiao M, Hsu JR, STReC (Skeletal Trauma Research Consortium). Staged correction of an equinovarus deformity due to pyoderma gangrenosum using a Taylor spatial frame and tibiotalar calcaneal fusion with an intramedullary device. 2011; 6 (3):173-176.
Pyoderma gangrenosum is a rare autoinflammatory syndrome manifested by skin lesions eventually creating ulcers. Surgical management can lead to scarring and contracture at the site of the lesion due to the pathergy phenomenon. A 43-year-old woman presented with a 5-year history of severe equinovarus deformity due to chronic pyoderma gangrenosum on her posteromedial ankle. She underwent a staged fusion. A gradual “closed” correction was performed in a Taylor spatial frame for 8 weeks in order to obviate the need for a surgical release in the area of the ulcer. She was ambulatory and full weight-bearing within 4 weeks of her frame removal. She maintained her correction with an accommodative foot orthosis until she had an uneventful tibiotalar calcaneal fusion with an intramedullary device. This case represents the success of using a Taylor spatial frame for staged fusion involving soft-tissue correction of severe, rigid equinovarus deformity due to pyoderma gangrenosum.
Su WP, Davis MD, Weenig RH, Powell FC, Perry HO (2004) Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 43:790-800
Fonder MA, Lazarus GS, Cowan DA, Aronson-Cook B, Kohli AR, Mamelak AJ (2008) Treating the chronic wound: a practical approach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol 58:185-206
Ma G, Jones G, MacKay G (2002) Pyoderma gangrenosum: a great marauder. Ann Plast Surg 48(5):546-552
Su WPD, Schroeter AL, Perry HO, Powell FC (1986) Histopathologic and immunopathologic study of pyoderma gangrenosum. J Cutan Pathol 13:323-330
Gettler S, Rothe M, Grin C et al (2003) Optimal treatment of pyoderma gangrenosum. Am J Clin Dermatol 4:597-608
Brooklyn TN et al (2006) Infliximab for the treatment of pyoderma gangrenosum: a randomized, double blind, placebo controlled trial. Gut 55:505-509
Chiba T, Isomura I, Suzuki A et al (2005) Topical tacrolimus therapy for pyoderma gangrenosum. J Dermatol 32:199-203
Callen JP, Jackson JM (2007) Pyoderma gangrenosum: an update. Rheum Dis Clin N Am 33:787-802
Younger ASE, Hansen ST (2005) Adult cavovarus foot. J Am Acad Orthop Surg 13:302-315
Simon SR et al (2000) Kinesiology. In: Buckwalter JA, Einhorn TA, Simon SR (eds) Orthopaedic basic science: biology and biomechanics of the musculoskeletal system, 2nd edn. American Academy of Orthopaedic Surgeons, Rosemont, pp 731-827
Sammarco GJ, Taylor R (2001) Combined calcaneal and metatarsal osteotomies for the treatment of cavus foot. Foot Ankle Clin 6:533-543
Giannini S, Ceccarelli F, Benedetti MG, Faldini C, Grandi G (2002) Surgical treatment of adult idiopathic cavus foot with planar fasciotomy, naviculocuneiform arthrodesis, and cuboid osteotomy. J Bone Joint Surg Am 84(Supp 2):62-69
Catagni MA (2002) Hindfoot. In: Maiocchi AB (ed) Atlas for the insertion of transosseous wires and half-pins: ilizarov method. Medi Surgical Video, Italy, p 45
Conway JD (2008) Charcot salvage of the foot and ankle using external fixation. Foot Ankle Clin N Am 13:157-173
Greisberg J (2004) Recent innovations and future directions in external fixation of the foot and ankle. Foot Ankle Clin N Am 9:637-647
Pinzur MS (2008) Simple solutions for difficult problems: a beginner's guide to ring fixation. Foot Ankle Clin N Am 13:1-13
Beaman DN, Bellman RG (2008) The basics of ring external fixator application and care. Foot Ankle Clin N Am 13:15-27
