Caudal Regression Syndrome with Pressure Ulcers of the Foot: A Case Report

Abstract

Caudal Regression Syndrome (CRS) is a rare disorder which consists of abnormalities in the lumbosacral spine, rectum, urinary system and lower limbs. These abnormalities also include orthopaedic deformities, such as hip dislocation, knee-flexion contracture with popliteal webbing and talipes equinovarus. Because of the rarity of this condition, few medical personnel are aware of it. Here, we present a case of CRS in a 15-year-old girl with pressure ulcers on the lateral malleolus and plantar surface of the foot, which had come into contact with the wheelchair footrest. Although the foot [Table/Fig-1]: Appearance of the pressure ulcer on the ankle. [Table/Fig-2]: Appearance of the pressure ulcers on the planter surface of the foot. [Table/Fig-3]: A 15-year-old girl had deformed lower limbs and congenital talipes equinovarus. (Images from left to right) [Table/Fig-4a,b]: Radiograph of the patient at eight-years-old shows the agenesis of the spine L1 through L5 with complete disconnection and confirms the earlier diagnose of CRS when the patient was infant. [Table/Fig-5]: The lateral malleolar defect after the debridement, showing the outline of a lateral supramalleolar flap. [Table/Fig-6]: Appearance at 18 months after surgery. Stable coverage and good contour were obtained. (Images from left to right) ulcers healed after off-loading, the ulcer on the lateral malleolus did not heal with conservative treatment and was covered by a lateral supramalleolar flap after debridement. Stable coverage and good contours were present at 18 months postoperatively. CRS patients may have a risk factor for developing pressure ulcers of the foot due to the characteristic lower limb deformities and a loss of sensation. Preventive foot care measures such as off-loading devices combined with modern dressings should be applied as routine when the medical personnel is to attend such patients.

Keywords

• caudal dysgenesis
• lower extremity deformities
• perforator flap