Keloid formation in a simple syndactyly release: a case report

Keloid formation on the palms of the hands and soles of the feet is rare. A keloid developed 2 months after release of simple syndactyly in a young black child. The process of keloid formation is not completely understood, and surgical correction is not effective.

A systematic approach to repair of syndactylism

An approach to the repair of syndactyly is presented whereby the web space is dissected in anatomically defined planes. This technique is preferred because it allows a reliable means of removing interdigital fibrofatty tissue while preserving the neurovascular bundles. Digital contour is improved and wound healing is promoted by less skin tension due to removal of the fibrofatty tissue.

Popliteal pterygium syndrome with special consideration of the cleft malformation: case report

This report describes a new case of popliteal pterygium syndrome (PPS) and also a treatment protocol. The patient presented with the complete complex of PPS and additional abnormalities that have not been described in the literature: a sinus of the upper lip, an extreme hypopoplastic prolabium with aplasia of the vestibule in this area, and a velar pterygium.

The pulp plasty: a composite graft for complete syndactyly fingertip separations

Composite grafts of skin and subcutaneous fat harvested from the glabrous non-weight-bearing areas of the foot were used to graft 34 fingertips after separation of 23 complete syndactyly webs in 13 patients. Simple complete syndactylies accounted for 17% and complex complete syndactylies accounted for 83%; synonychia was encountered in 70%. Follow-up averaged 13.9 months (minimum, 2 months, maximum 33 months). All patients had 100% take of the composite graft. Subjective gradings were 94% good, 6% fair, and there were no poor results. This technique provides a relatively normal contour and satisfactory pad to the fingertip.

Nonadjacent syndactyly in the congenital constriction band syndrome

Hand anomalies in the amniotic band sequence are frequently both complex and difficult to explain in terms of our conventional understanding of limb embryogenesis. A case manifesting pseudosyndactyly between nonadjacent fingers confirms the role of an in utero disturbance after the seventh week, in concert with close apposition between nearby but not adjacent parts.

The ring constriction syndrome

This series of 37 cases treated by the author over a twenty-seven year period, covers the full spectrum of deformity produced by this condition. These include simple ring constrictions, those with a distal atrophy or oedema, digit fusions, and amputations.

Ilizarov technique in treatment of congenital hand anomalies. Two case reports

An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities.

A three-flap web-plasty for release of short congenital syndactyly and dorsal adduction contracture

This article describes a technique for interdigital web space deepening, which is applicable to incomplete syndactyly proximal to the proximal interphalangeal joint and to dorsal web space adduction contracture resulting from thermal injury. It consists of a dorsal rectangular flap and two palmar triangular flaps. The flaps are reversed to release dorsal adduction contracture. This procedure provides a broad commissure with a natural slope. A skin graft is avoided. A mathematical model shows that when the length-width ratio of the flaps is 1:1, the surface area of each flap is greater than or equal to the surface area of the defect it covers and the length of every flap edge is equal to or greater than its corresponding defect edge. If a web has a low apex angle and the skin is elastic, the length-width ratio may be as great as 1.5:1. The flaps will still cover the defects and small inequalities between certain flap and defect edges will be accommodated.

Desyndactylization: a unique case report

Syndactylism is a congenital or acquired anomaly in which there is persistence of webbing between adjacent digits. It occurs in 1:2000 to 1:2500 live births, three times more commonly in males, and most often between the middle and third fingers. In the foot, syndactyly involves the second and third toes most frequently. Generally, this is thought of as a cosmetic condition when associated with the toes of the foot, as this usually causes little functional loss. The authors present a unique case report of syndactyly of the hallux and second toe in a 66-year-old black female and its surgical repair for painful hammertoe deformity.

Syndactyly correction of the hand in Apert syndrome

Surgical correction of syndactyly of the Apert hand should begin by 6 months and be completed by 3 years of age. As much surgery as possible is carried out at each sitting. Digit separation should be in order of functional importance. The first web space is deepened with a four-flap Z-plasty or a dorsal skin flap from the web and index finger. Syndactyly release using a dorsal flap and zig-zag technique is used to create the second and fourth web spaces. The complex long-ring syndactyly often requires a pedicled groin flap for reconstruction and preservation of growth potential. A five-digit hand can be achieved with adequate grasp and stable, sensate, well-aligned digits. These children can attain some degree of independent finger motion and aesthetically acceptable hands with this approach.

Local epidermoplasty for syndactyly

A new method of treating syndactyly is described. The fingers are separated by graduated steps in a special apparatus using skeletal fixation of the phalanges with wires. Skin grafting is then carried out. Scarring and deformity are avoided. The operation can be used for very young children and our patients were aged from 5 months to 30 years. The results of 60 operations are reviewed: 56 were good, 3 satisfactory and 1 unsatisfactory. The advantages of the procedure are discussed.

A double pulp flap technique for creating nail-folds in syndactyly release

A method is described of creating nail-folds in the release of cases of complete syndactyly. A double pulp flap was used as a one-stage technique in 13 patients in whom webs were separated. All patients were reviewed after a minimum of one year. Fullness of pulp was achieved in all fingers. The nail-fold was considered normal in 14 of 18 fingers covered with a broad flap and in 8 of 18 fingers covered with a narrow flap. In the remaining cases the nail-fold was small but never absent. No flap loss was encountered and there was no late nail deformity from scarring.

[Polydactyly]

The authors reports the experience of the plastic surgery unit in the Kassab's Institute of Orthopedics in Tunis. This series consists of 44 cases of polydactyly dominated by duplication of the little finger and the thumb. A slight male predominance was observed and the mean age at surgery was 8 years. Two types of polydactyly were observed: simple, such as rudimentary digits, complex, with associated bone malformation or syndactyly. In ulnar polydactyly, associated duplication of the toes in frequently noted. The most frequent surgical approach was amputation of the more dystrophic finger with reconstruction and correction of the other congenital malformation observed. Some cases of digital redistribution were also performed. A review of the literature is presented together with an objective analyse of esthetic and functional results.

Surgical method for treatment of syndactyly with osseous fusion of the distal phalanges

For the interdigital space plasty to correct a syndactyly with fusion of the distal phalanges, we adopted a new operative procedure, covering the exposed distal bone with local rectangular flaps designed transversely on both dorsal and volar surfaces. A full-thickness skin graft from the groin region covers the remaining raw surface. The procedure was performed in six patients, and the flaps measured 6 mm (width) x 12 to 16 mm (length) in four patients, 5 x 15 mm in one patient, and 5 x 18 mm in one patient. Partial necrosis was observed in only one patient, in whom a narrow flap of 5 x 18 mm was used. In the other five patients, however, the results were satisfactory on both external appearance and function during the follow-up period of 3 to 6 years.

Syndactyly

Congenital syndactyly is associated with a wide spectrum of local anomalies that strongly influence the ultimate outcome of treatment. Surgical options, indications, timing, and prognosis are all determined by the preoperative degree of deformity. The surgeon must apply knowledge of anatomic variations and adhere to fundamental principles of technique, which are reviewed in detail.

Cleft hand

Definition, incidence, genetics, and etiology of typical cleft hand are discussed in this paper. Cleft hand, central polydactyly, and osseous syndactyly were induced experimentally when the same teratogenic factors acted on the embryos at the same developmental stage. Typical cleft hand, central polydactyly, and syndactyly should be classified together as manifestations of the same entity, that is, failure of induction of finger rays. Typical cleft hand may be further subdivided into five types on the basis of the number of defective finger rays. Treatment of the typical cleft hand involves cosmetic and functional considerations. Reduction of the wide interdigital space is performed primarily for cosmetic reasons, while separation of syndactyly between thumb and index finger and correction of deviation of the thumb is performed for functional improvement. A zigzag incision with a small triangular flap is recommended for reduction of the interdigital space. If metacarpal remnants or cross bones prevent drawing the metacarpals together, they should be removed. The deep transverse metacarpal ligament should be reconstructed by ligamentous flap made out of the flexor tendon sheaths of the index and ring fingers to prevent later spreading of the fingers. A dorsal-based rotation flap fashioned from the skin of the cleft is recommended for the treatment of cleft hand with partial syndactyly of the thumb and index finger. Deviation of the thumb is often caused by a delta phalanx by a trapezoidal-shaped extra phalanx. Deviation of the thumb is corrected by removing the delta phalanx or osteotomy of the trapezoidal phalanx. When the cleft is closed at approximately 1 year of age, spontaneous correction of the flexion deformity of the ring finger is sometimes observed.

Super digit

This article describes a clinical entity under the new name "super digit." The anomaly represents a conglomerate of several different malformations and syndromes. Twenty patients with 24 super digits are presented. The two main types of super digits are discussed: Type I, which has two metacarpals that support a single oversized digit; and Type II, which has a single metacarpal that supports two or more digits distally. These digits, with growth, display several complications such as enlargement, deviation, angulation, loss of motion, and undergrowth. The anomalies singly and collectively present problems that require similar surgical procedures for correction.

Desyndactyly: a literature review

An historical review of the literature dating from the early 1800s to the present reveals numerous methods that have been reported for the repair of syndactyly. This paper presents descriptions and diagrammatic illustrations of selected surgical procedures. Surgical intervention with the use of skin flaps to repair syndactyly almost always results in deficiency of skin. Either full thickness or porcine skin grafts to cover the adjacent sides of the desyndactylized digits generally should be used to avoid the postoperative complications inherent with the isolated use of skin flaps.

Upper extremity burn contractures

Upper extremity burn contractures are a major challenge to the reconstructive surgeon. Despite increasing sophistication in the overall management of acute thermal injuries, contractures still occur and are the most common cause of skin contracture in the hand. Reconstructive options for axillary, antecubital, wrist, metacarpophalangeal joint, and interdigital web contractures are discussed, with special emphasis on the techniques and advantages of local flap reconstruction.

Syndactyly: Can Web Creep be avoided?

Syndactyly is one of the most common congenital hand deformities but there still remains a high incidence of contractures and web creep after attempts at surgical correction using many assorted techniques. Little attention has been paid to the potential junctional scar in the aetiology of web creep. To remedy this, a technique is described which involves a dorsal flap and two palmar laterally-based flaps. This method not only breaks up the palmar junctional scar but also completely reconstructs the web, not just the floor. The procedure can be used in all varieties of syndactyly and has reduced the incidence of creep in a series of 49 webs.

[Absence of blood circulation following toe-hand transplantation in a 7-year-old girl with monodactyle form of symbrachydactyly]

In a toe transplantation in a child with symbrachydactyly the authors were faced with a no-reflow phenomenon. The medication they used in prophylaxis was not an absolute guarantee to prevent this problem. Success also depends on some general measures, as a stable blood pressure, a constant blood volume, normal body temperature, short operation time, and an early revision in case of a no-reflow phenomenon. Some questions about the appearance of spasm still remain: are they provoked by pain, stress, medication as anaesthetics, or is a congenital structural vessel problem responsible?

Tibial hypo-/aplasia with preaxial syn- and polydactyly

Tibial hypo-/aplasia with preaxial syn- and polydactyly is a rare autosomal dominant condition. Fewer than 20 cases have so far been described. One is presented here.

Pedal macrodactyly treated by digital shortening and free nail graft; a report of two cases

Two cases of macrosyndactyly of the foot are reported which were successfully treated by shortening of the affected digits and free nail grafting.

The reverse dorsal metacarpal flap

The dorsal metacarpal vessels contribute to the fascial plexus which supplies the skin of the dorsum of the hand. We have successfully used eight reverse dorsal metacarpal flaps based on the dorsal metacarpal arteries. The design and use of the reverse dorsal metacarpal flap is described; it appears to have a reliable vascular basis and its usefulness in covering small soft tissue defects in the hand is illustrated.