Il Jung Park

Treatment of Popliteal Pterygium Using an Ilizarov External Fixator

Popliteal pterygium syndrome is a rare congenital disorder that consists of popliteal webs and craniofacial, genitourinary and extremity anomalies. Only moderate successful surgical excision of the fibrotic band within the popliteal web has been reported because the nerves and vessels in the affected site are short and displaced into the web and they are attached to adjacent tissues. We performed hamstring tenotomy on the ischial tuberosity, tenotomy of the flexor hallucis longus and Z-lengthening of the Achilles tendon on the ankle in our patient, and this was followed by gradual correction using an Ilizarov external fixator. Full extension of the knee joint was achieved at the ninth postoperative week. However, some recurrence of flexion contracture was noted at two years follow-up. Gradual soft tissue lengthening with an Ilizarov external fixator can be one of the optimal procedures when excision of a fibrous band and Z-plasty are not possible due to severe adhesion of the nerves and vessels into a fibrotic band. However, a cautious approach is recommended when considering the high risk of recurrence.

Ganglion Cyst of the Great Toe

Purpose: To evaluate the clinical features and treatment of ganglion cyst of the hallux. Materials and Methods: From August 1990 to December 2002, seven patients with a ganglion cyst of the hallux were treated. Six cases underwent surgical excision and one repeated aspiration. Results: Four cases showed recurrence after the initial surgical excision. Characteristics of the ganglion cyst of the hallux were; (1) mass accompanied by pain, (2) frequent recurrence after surgical excision, and (3) frequent communication with a joint. In one case of ganglion communicating with the interphalangeal joint, the joint of the involved hallux was finally fused due to repeated recurrence. Conclusion: Ganglion cyst of the great toe needs to be evaluated by specialized study such as MRI for joint comminucation, and treated by meticulous surgical excision to prevent recurrence.