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Garcia-Fernández J, Galán-Olleros M, Fraga-Collarte M, Ramírez-Barragán A, Martínez-González C, Martínez-Caballero I. Mid-term outcomes of talar neck trapezoidal osteotomy for correction of severe rigid neurologic equinovarus foot. Foot Ankle Surg 2025:S1268-7731(25)00003-7. [PMID: 39818475 DOI: 10.1016/j.fas.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 12/14/2024] [Accepted: 01/02/2025] [Indexed: 01/18/2025]
Abstract
BACKGROUND Severe rigid neurologic equinovarus foot (NEVF) deformity, though rare, significantly limits transfers and orthotic use in pediatric patients with neurological disorders. Standard treatments like arthrodesis or talectomy are highly invasive, especially in young patients. This study assesses the mid-term outcomes of a talar neck trapezoidal osteotomy (TNTO) to correct severe NEVF in non-ambulatory patients. METHODS A retrospective analysis included severe NEVF patients treated with TNTO and muscle rebalancing (2015-2019). Radiographic assessments evaluated alignment and avascular necrosis, while functional outcomes and caregiver satisfaction were recorded RESULTS: Nine patients (56 % male; median age 11, IQR: 9.2-11.2) with a median follow-up of 53.3 months (IQR: 42.4-80.1) showed significant improvements in alignment (p < 0.05) and function (p < 0.05). Caregiver satisfaction was high (100 %), with one patient experiencing asymptomatic partial avascular necrosis. CONCLUSIONS TNTO is a safe, effective option for correcting severe NEVF, achieving positive outcomes in foot alignment, orthotic use, and caregiver satisfaction mid-term.
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Affiliation(s)
- Jaime Garcia-Fernández
- Neuro-Orthopedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - María Galán-Olleros
- Neuro-Orthopedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Manuel Fraga-Collarte
- Neuro-Orthopedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ana Ramírez-Barragán
- Neuro-Orthopedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Carmen Martínez-González
- Neuro-Orthopedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ignacio Martínez-Caballero
- Neuro-Orthopedic Unit, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Grzeskiewicz EM, Santee P, Shah S, Groth A, Martin KD. Arthroscopic Releases and Hindfoot Fusion for Spastic Equinovarus Foot Deformities, An All-Inside Technique. Arthrosc Tech 2023; 12:e2219-e2225. [PMID: 38196881 PMCID: PMC10772970 DOI: 10.1016/j.eats.2023.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/29/2023] [Indexed: 01/11/2024] Open
Abstract
Neurologic foot contractures pose a challenging situation for orthopaedic surgeons. These deformities are long-standing problems for patients with acute brain injuries, ultimately affecting their quality of life. We report our experience with using arthroscopic assisted, minimally invasive contracture tenotomies paired with a tibio-talo-calcaneal arthrodesis to achieve improved alignment and functional reconstruction of spastic equinovarus foot deformities.
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Affiliation(s)
- Elise M. Grzeskiewicz
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Paige Santee
- The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
| | - Sachin Shah
- The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
| | - Adam Groth
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kevin D. Martin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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Bakircioglu S, Danisman M, Tuncay O, Kolac UC, Bulut MA, Yilmaz G. Complex rigid foot deformity correction with hexapod external fixator system. INTERNATIONAL ORTHOPAEDICS 2023; 47:2773-2780. [PMID: 37460652 DOI: 10.1007/s00264-023-05897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Complex rigid foot deformities include three-plane deformities and usually presents with poor soft tissue coverage. In the last decades, gradual correction with computer-assisted fixator became an appropriate option for the treatment rigid foot deformities. This study aims to report our experience about treatment of complex foot deformities using Smart Correction fixator system®. METHODS We retrospectively analyzed 13 complex rigid foot deformities of ten consecutive patients treated with Smart Correction fixator system® from 2016 to 2020. Primary outcomes were classified as good, fair, and poor according to previously determined criteria. The outcomes were also assessed with The Manchester-Oxford Foot Questionnaire (MOXFQ). Non-parametric analysis (Wilcoxon test) for continuous variables and the Fisher's exact test for categorical variables were used. RESULTS Plantigrade foot was achieved in all patients after correction program. Supramalleolar osteotomy was applied in nine feet, midfoot osteotomy was applied in two feet, hindfoot osteotomy was required in one foot, and only soft tissue distraction performed in two feet. Two patients had recurrent deformity managed by further acute corrections. The mean MOXFQ scores improved from 72.7 preoperatively to 24.8 at last follow-up. CONCLUSIONS Present study shows that SCF the reliable option for the treatment of complex foot deformities, which also facilitates three-plane correction and concomitant lengthening with gradual soft tissue balance.
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Affiliation(s)
- Sancar Bakircioglu
- Department of Orthopedics and Traumatology, TOBB Economy and Technology University, Ankara, Turkey.
| | - Murat Danisman
- Department of Orthopedics and Traumatology, Giresun University, Giresun, Turkey
| | - Ozan Tuncay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Ulas Can Kolac
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Muhammed Abdulkadir Bulut
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Guney Yilmaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
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Boquan Q, Yi R, Tingjiang G, Xi L, Hui Z. Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release. J Orthop Surg Res 2020; 15:492. [PMID: 33097068 PMCID: PMC7585178 DOI: 10.1186/s13018-020-02021-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023] Open
Abstract
AIM The aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results. METHODS A retrospective review of CFD associated with LLD simultaneous correction utilizing the Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted. RESULTS Thirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient and lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, the ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study. CONCLUSION The therapeutic strategy by using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Qin Boquan
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China.,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ren Yi
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China.,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Gan Tingjiang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China.,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Liu Xi
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China.,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zhang Hui
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China. .,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Boffeli TJ, Collier RC, Neubauer EF, Malay DS. Surgical Outcomes After Minimally Invasive Release of Stroke-Related Equinovarus Contracture of the Foot and Ankle. J Foot Ankle Surg 2019; 58:1108-1117. [PMID: 31679664 DOI: 10.1053/j.jfas.2019.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 02/03/2023]
Abstract
Cerebrovascular accident frequently causes spastic equinovarus contracture of the foot and ankle, for which traditional surgical correction involves tendon transfer, osteotomy, and hindfoot fusion, which can be challenging for patients after cerebrovascular accident. We prospectively assessed the efficacy of a minimally invasive, ambulatory approach to correct this complex deformity in 12 consecutive patients. Surgery included Achilles tendon lengthening, lengthening of the posterior tibial tendon, and flexor tenotomy of all 5 digits. The 10-cm visual-analog scale and the Bristol Foot Score were used to assess pain and subjective foot-related quality of life, respectively. The mean patient age was 61.5 ± 5.68 years, and the duration of follow-up was 29.3 ± 18.5 (range 12.2 to 63.3) months. All patients had a preoperative equinovarus foot structure and all had a rectus foot in weightbearing stance at the 1-year postoperative evaluation. Nine (75.0%) patients showed no residual or recurrent deformity, whereas 3 (25.5%) displayed incomplete release of digital contractures; all patients were treated with in-office flexor tenotomy. Preoperative maximum ankle dorsiflexion was ≤90° in 12 (100%) patients and >90° in 9 (75.0%) patients postoperatively. The mean visual-analog scale score decreased in 10 (83.3%) patients, although a statistically significant decrease was not observed (p = .0535). The Bristol Foot Score improved from 55.17 ± 11.10 preoperatively to 36.83 ± 13.26 postoperatively, and this improvement was statistically significant (p = .0022). These outcomes demonstrate the effectiveness of the minimally invasive, ambulatory surgical approach to spastic equinovarus contracture without identified patient harm.
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Affiliation(s)
- Troy J Boffeli
- Director, Foot & Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education & Research, St. Paul, MN.
| | - Rachel C Collier
- Attending, Foot & Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education & Research, St. Paul, MN
| | - Elizabeth F Neubauer
- Resident, Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN
| | - D Scot Malay
- Director of Podiatric Research and Staff Surgeon, Penn Presbyterian Medical Center, Philadelphia, PA
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Chen ZY, Wu ZY, An YH, Dong LF, He J, Chen R. Soft tissue release combined with joint-sparing osteotomy for treatment of cavovarus foot deformity in older children: Analysis of 21 cases. World J Clin Cases 2019; 7:3208-3216. [PMID: 31667171 PMCID: PMC6819307 DOI: 10.12998/wjcc.v7.i20.3208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cavovarus foot is a common form of foot deformity in children, which is clinically characterized by an abnormal increase of the longitudinal arch of the foot, and it can be simultaneously complicated with forefoot pronation and varus, rearfoot varus, Achilles tendon contracture, or cock-up toe deformity. Muscle force imbalance is the primary cause of such deformity. Many diseases can lead to muscle force imbalance, such as tethered cord syndrome, cerebral palsy, Charcot-Marie-Tooth disease, and trauma. At present, many surgical treatments are available for cavovarus foot. For older children, priority should be given to midfoot osteotomy and fusion. Since complications such as abnormal foot length, foot stiffness, and abnormal gait tend to develop postoperatively, it is important to preserve the joints and correct the deformity as much as possible. Adequate soft tissue release and muscle balance are the keys to correcting the deformity and avoiding its postoperative recurrence.
AIM To assess the efficacy of soft tissue release combined with joint-sparing osteotomy in the treatment of cavovarus foot deformity in older children.
METHODS The clinical data of 21 older children with cavovarus foot deformity (28 feet) who were treated surgically at the Ninth Department of Orthopedics of Jizhong Energy Xingtai Mining Group General Hospital from November 2014 to July 2017 were retrospectively analyzed. The patients ranged in age from 10 to 14 years old, with an average age of 12.46 ± 1.20 years. Their main clinical manifestations were deformity, pain, and gait abnormality. The patients underwent magnetic resonance imaging of the lumbar spine, electromyographic examination, weight-bearing anteroposterior and lateral X-rays of the feet, and the Coleman block test. Surgical procedures including metatarsal fascia release, Achilles tendon or medial gastrocnemius lengthening, "V"-shaped osteotomy on the dorsal side of the metatarsal base, opening medial cuneiform wedge osteotomy, closing cuboid osteotomy, anterior transfer of the posterior tibial tendon, peroneus longus-to-brevis transfer, and calcaneal sliding osteotomy to correct hindfoot varus deformity were performed. After surgery, long leg plaster casts were applied, the plaster casts were removed 6 wk later, Kirschner wires were removed, and functional exercise was initiated. The patients began weight-bearing walk 3 mo after surgery. Therapeutic effects were evaluated using the Wicart grading system, and Meary’s angles and Hibbs’ angles were measured based on X-ray images obtained preoperatively and at last follow-up to assess their changes.
RESULTS The patients were followed for 6 to 32 mo, with an average follow-up period of 17.68 ± 6.290 mo. Bone healing at the osteotomy site was achieved at 3 mo in all cases. According to the Wicart grading system, very good results were achieved in 18 feet, good in 7, and fair in 3, with a very good/good rate of 89.3%. At last follow-up, mean Meary’s angle was 6.36° ± 1.810°, and mean Hibbs’ angle was 160.21° ± 4.167°, both of which were significantly improved compared with preoperative values (24.11° ± 2.948° and 135.86° ± 5.345°, respectively; P < 0.001 for both). No complications such as infection, skin necrosis, or bone nonunion occurred.
CONCLUSION Soft tissue release combined with joint-sparing osteotomy has appreciated efficacy in the treatment of cavovarus foot deformity in older children.
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Affiliation(s)
- Zhen-Yu Chen
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Zhan-Yong Wu
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Yue-Hui An
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Li-Fei Dong
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Jia He
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Run Chen
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
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Kiskaddon EM, Meeks BD, Roberts JG, Laughlin RT. Plantar Fascia Release Through a Single Lateral Incision in the Operative Management of a Cavovarus Foot: A Cadaver Model Analysis of the Operative Technique. J Foot Ankle Surg 2018; 57:681-684. [PMID: 29627135 DOI: 10.1053/j.jfas.2017.11.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Indexed: 02/03/2023]
Abstract
Plantar fascia release and calcaneal slide osteotomy are often components of the surgical management for cavovarus deformities of the foot. In this setting, plantar fascia release has traditionally been performed through an incision over the medial calcaneal tuberosity, and the calcaneal osteotomy through a lateral incision. Two separate incisions can potentially increase the operative time and morbidity. The purpose of the present study was threefold: to describe the operative technique, use cadaveric dissection to analyze whether a full release of the plantar fascia was possible through the lateral incision, and examine the proximity of the medial neurovascular structures to both the plantar fascia release and calcaneal slide osteotomy when performed together. In our cadaveric dissections, we found that full release of the plantar fascia is possible through the lateral incision with no obvious damage to the medial neurovascular structures. We also found that the calcaneal branch of the tibial nerve reliably crossed the osteotomy in all specimens. We have concluded that both the plantar fascia release and the calcaneal osteotomy can be safely performed through a lateral incision, if care is taken when completing the calcaneal osteotomy to ensure that the medial neurovascular structures remain uninjured.
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Affiliation(s)
- Eric M Kiskaddon
- Resident Physician, Department of Orthopaedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Dayton, OH.
| | - Brett D Meeks
- Resident Physician, Department of Orthopaedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Dayton, OH
| | - Joseph G Roberts
- Medical Student, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Richard T Laughlin
- Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Dayton, OH
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Nickel KJ, Van Slyke AC, Knox AD, Wing K, Wells N. Tissue Expansion for Severe Foot and Ankle Deformities: A 16-Year Review. Plast Surg (Oakv) 2018; 26:244-249. [PMID: 30450342 DOI: 10.1177/2292550317749510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tissue expansion in the lower extremity is controversial, with studies reporting complication rates as high as 83%. Few studies have looked at tissue expansion prior to orthopaedic correction of severe foot and ankle deformities, and those available are restricted to clubfoot in the pediatric population. Here, we report the largest case series on the use of tissue expanders for the reconstruction of severe foot and ankle deformity and the only report in adults. Methods This is a retrospective chart review of the senior author's practice over a 16-year study period. All patients over 18 years of age who underwent tissue expansion prior to definitive orthopaedic correction of a severe foot and ankle deformity were included. Patient demographics, etiology of deformity, rate of expansion, and complications were recorded. Major complications were defined as those which required surgical intervention. Data were analyzed using descriptive statistics. Results Nineteen cases were performed on 16 patients. Our overall complication rate was 31.6% (6/19), with major complications occurring in 21.1% (4/19) of cases, and minor complications occurring in 10.5% (2/19) of cases. Despite this, 94.7% (18/19) of cases went on to receive definitive orthopaedic correction after tissue expansion. No demographic parameters were associated with occurrence of complications. Conclusions This represents the largest report on lower extremity tissue expansion for severe foot and ankle deformity correction. While we observed complications in 31.6% of patients, 94.7% of cases went on to receive definitive orthopaedic correction with successful primary closure.
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Affiliation(s)
- Kevin J Nickel
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron C Van Slyke
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron D Knox
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Wing
- Department of Orthopedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil Wells
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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