Purpose:
To highlight the histopathological characteristics of the skin in congenital clubfoot
and correlate the clinical findings in clubfoot with the changes in the dermal
layers.
Materials and methods:
One hundred skin specimens, from 77 infants (6 to 12 months), were studied
between 2004 and 2008. Using the Pirani scoring system, the clinical severity
was recorded. The mobility of the skin and the correctability of the medial ray
were assessed clinically. A skin specimen (1cm x 1mm) was taken from the
medial side of the foot at surgery following failed plaster treatment. The layers
were studied under light microscopy. The thickness of the dermis and the
histopathological features of clubfoot skin were compared with 10 normal skin
specimens.
Results:
The dermis of clubfoot skin showed significant fibrosis with thick bundles of
collagen fibres (P = .001) on Haematoxylin and Eosin staining (H&E). The dermal
thickness ranged between 1.0mm and 5.2mm in clubfoot skin, compared with
controls (0.64-1.28mm). Fibrosis extended into the subcutis in a septolobular
fashion in 95% of the cases. Significant atrophy of eccrine glands was seen in
98% (P = .001). Hair follicles were absent in 78%. The elastic fibres of clubfoot
skin, stained with Elastic van Gieson staining (EVG), showed hypertrophy in
varying degrees in all skin specimens. They were fragmented, with loss of their
parallel arrangement. There was no significant inflammatory reaction in the
dermis. The Pirani score was significantly increased (mean 7.8).
Discussion:
Fibrosis and thickening of the dermis were the most significant histopathological
features of the clubfoot skin. The elastic fibres were also abnormal. There was
atrophy of the skin appendages due to the fibrosis. There was a strong
correlation between the Pirani score and the severity of the deformity(P 0.016).
The cases with poor outcome had a higher score than those with a satisfactory
outcome.Lack of a significant inflammatory reaction suggests that neither the
serial manipulations of the foot, nor the repeated plaster cast changes, were
responsible for the dermal fibrosis, which is probably present from birth and
contributes to the deformity. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ukzn/oai:http://researchspace.ukzn.ac.za:10413/9591 |
| Date | January 2012 |
| Creators | Rasool, Mahomed Noor. |
| Contributors | Govender, S., Ramdial, P. K. |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
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