Human skin allograft used to treat open wounds after club foot release.

Abstract

The inversion deformity of club foot is characterized by shortened ligaments and tendons on the medial side of the foot. The condition, when refractory to castings, is treated easily by operative intervention with neutralization of the foot and ankle. Closure of the resulting incision creates tension on the skin that is well tolerated in most children. Correction of severe deformities leaves incisions that will not close primarily, leaving tendons and neurovascular structures exposed on the posteromedial aspect of the foot. Free tissue transfer or spontaneous secondary closure are 2 options that have drawbacks. Application of human skin allograft affords protection to underlying tissue while allowing granulation tissue formation and wound contraction. Subsequent skin autograft and secondary skin contraction and epithelialization provide satisfactory wound closure with normal foot contour and preservation of ankle correction. Complete healing is achieved by the time cast immobilization is discontinued 6 weeks after surgery.