Outcome of Atypical & Complex Clubfoot Managed by Modified Ponseti Method-A Prospective Study.

Atypical or complex clubfoot constitutes a small number of cases. Due to the difference in complexity of anatomy, standard deformity correction by Ponseti is not effective. Hence a modified Ponseti method was advised which focuses on deformity differences for treatment. We conducted a prospective study to analyze the outcome in atypical or complex clubfoot treated with the modified Ponseti method. All the children of age less than 1 year were included in the study with atypical or complex clubfoot. Every case was treated according to the modified Ponseti method and tenotomy. Pirani scores were measured at pretreatment, each visit, before application of a brace, and at the latest follow-up. Statistical analysis of all continuous and categorical variables was done. A total of 30 patients (47 feet) were included in the study. Mean Pirani score improved from 5.69 at presentation to 0.45 at time of brace application and latest follow-up 0.34 (p < .001). Six patients (9 feet) had a relapse which was managed with recasting. The mean Pirani score of relapse was 0.72, which after correction reduced to 0.11 (p = .008). Six patients had cast-related complications which were managed with conservative treatment. With an increase in popularity of the Ponseti method, a greater number of complex clubfoot cases are seen due to inadequate reduction or slippage of cast or improper cast application techniques. All these need to be identified at an early age. This helps in proper treatment and improves the quality of life as well as foot appearance.

Scaffolds: A Novel Carrier and Potential Wound Healer.

A scaffold is comprised of the polymeric central components, which are used to deliver cells, drugs, and genes into the body. Wounds, which lead to a loss of integrity of the skin and skin mortality, are common challenges encountered in plastic and reconstructive surgery. The primary goals of treatment are rapid closure, restoration of function, and aesthetic satisfaction. A paradigm shift is taking place in medicine from using synthetic implants and tissue grafts to a tissue-engineering approach that uses degradable porous material scaffolds integrated with biological cells or molecules to regenerate tissues. Scaffold structure is a novel carrier for cell and drug delivery that enhances wound healing through differentiation of endothelial and epithelial cells and production of angiogenic growth factors in cutaneous wounds. Currently, scaffolds have application in various fields of tissue engineering in repair of nasal and auricular malformations, in bone formation, in cartilage development, in periodontal regeneration, as artificial corneas, as heart valves, in ligament replacement, in tendon repair, and in tumours. In the present review, we emphasize the role of scaffolds in wound healing, and we outline types of scaffolds, properties, techniques adopted, materials used, and their applications in tissue engineering.