WOUND HEALING FOLLOWING PARTIAL CLOSURE OF THE CINCINNATI INCISION FOR SURGERY OF CONGENITAL TALIPES EQUINOVARUS

Abstract

The Cincinnati incision is widely utilized in clubfoot surgery and allows excellent access to the medial, lateral and posterior structures involved. Closure of the skin at the end of the procedure without undue tension may be difficult. Wound necrosis and excessive scarring may occur and may lead to inadequate correction. One alternative is to splint the foot in an initial equines position post-operatively with repeat cast changes to achieve optimal position once soft tissue swelling has decreased. A further method is to leave the wound open and allow it to granulate.

The healing and final cosmetic appearance of wounds allowed to heal by granulation following the Cincinnati incision were reviewed.

We reviewed 14 feet in 10 patients who had undergone partial closure of the Cincinnati incision following peritalar release. The majority of the children were male and the average age at surgery was 28 weeks. All corrections were performed as primary procedures on patients with idiopathic CTEV. At the end of the procedure an above-knee plaster was applied. The plaster was changed weekly in the outpatients department until the wound had healed. Patients were maintained in plaster for 12 weeks.

All final wounds were cosmetically acceptable both to the surgeon and the parents. The widest scar was 3 mm and the average time to heal four weeks. No infection had occurred although two wounds were treated for overgranulation.

Partial wound closure of the Cincinnati incision avoids undue tissue tension and allows a fully corrected position of the foot to be maintained at the end of the initial procedure. A second anaesthetic to obtain further correction is therefore avoided. Partial wound closure leaves cosmetically acceptable scarring with minimal complications. Parents should be warned about the initial appearance of the wound but may be reassured regarding final outcome.