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Zhu Y, Xu Y, Pu S, Lv Q, Cai X, Zhao Y. Metacarpal Lengthening Using a Mini-Ring Ilizarov Device for Thumb Reconstruction. J Hand Surg Am 2024; 49:708.e1-708.e6. [PMID: 36925407 DOI: 10.1016/j.jhsa.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/20/2022] [Accepted: 09/15/2022] [Indexed: 03/18/2023]
Abstract
PURPOSE To explore the results of using the mini-ring Ilizarov external fixator for thumb metacarpal lengthening and its compatibility with a simultaneous groin flap. METHODS From May 2016 to June 2019, 17 adult patients with thumb loss were treated with metacarpal lengthening using a mini-ring Ilizarov device. The device was composed of 2 rings, threaded rods, nuts, and K-wires (diameter, 1.5 mm). Of these patients, 6 also underwent simultaneous groin flap transfer. Lengthening was started 3 days after surgery at a rate of 0.66 mm/d. The pedicle of the groin flap was divided 1 month after the surgery. The healing index (days per cm), which denotes the number of days the external fixator is attached to the bone per centimeter of length gained, was used to evaluate the lengthening efficiency. RESULTS The patients were observed for 21.9 ± 9.0 months. The lengthening continued for 29.1 ± 4.5 days, resulting in an additional length of 1.9 ± 0.3 cm. CONCLUSIONS The mini-ring Ilizarov external fixator is a simple device for primary metacarpal lengthening. This device can be used with a groin flap for single-stage lengthening of injured thumbs with bone exposure. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Yueliang Zhu
- Department of Orthopedic Surgery. 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yongqing Xu
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, Kunming, People's Republic of China.
| | - Shaoquan Pu
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, Kunming, People's Republic of China
| | - Qian Lv
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, Kunming, People's Republic of China
| | - Xingbo Cai
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, Kunming, People's Republic of China; Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China
| | - Yonghui Zhao
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China.
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Hayashi K, Hattori Y, Sakamoto S, Gour V, Sasaki J, Doi K. Reconstruction of Total Hand Degloving Injury with Combined Free and Pedicled Flaps and Ilizarov Minifixator. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5976. [PMID: 39015359 PMCID: PMC11250239 DOI: 10.1097/gox.0000000000005976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/17/2024] [Indexed: 07/18/2024]
Abstract
Total hand degloving injuries present a significant challenge in treatment, with no consensus yet on the optimal choice of flap for coverage. Functional reconstruction necessitates careful consideration of syndactyly release, particularly after flap coverage. A 64-year-old woman sustained a total hand degloving injury and underwent extensive reconstructive surgery. Initially, a free superficial circumflex iliac perforator flap was applied to the thumb, whereas pedicled groin and superficial inferior epigastric artery flaps were used for the remaining fingers. However, partial necrosis at the edges of the pedicled flaps necessitated the adduction of the fingers, followed by suturing the skin flaps closed. This led to the formation of adduction contractures, requiring careful release and skin flap extension for effective syndactyly release. Subsequently, the innovative use of an Ilizarov minifixator was used for the dual purpose of interdigital widening and elongation of the flap. At the 27-month follow-up, the patient demonstrated significant functional recovery of the hand and fingers, showing the effectiveness of this multifaceted surgical approach. Despite some residual flexion contractures, the patient regained the ability to write and perform pinching motions with the thumb and middle finger, expressing satisfaction with the surgical outcome. In conclusion, for a functional reconstruction of the thumb and fingers, the thumb and other fingers should be covered separately. When the fingers are in adduction and there is insufficient skin stock for syndactyly release, using an external fixator to expand the interdigital spaces before the syndactyly release proved to be effective.
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Affiliation(s)
- Kota Hayashi
- From the Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Yasunori Hattori
- From the Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Sotetsu Sakamoto
- From the Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Vijayendrasingh Gour
- From the Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Jun Sasaki
- From the Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Kazuteru Doi
- From the Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
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Mahindroo S, Tabaie S. Syndactyly in the Pediatric Population: A Review of the Literature. Cureus 2023; 15:e36118. [PMID: 36937133 PMCID: PMC10016737 DOI: 10.7759/cureus.36118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Syndactyly is one of the most common congenital upper extremity deformities. Syndactyly can be described as either simple, involving just the skin and soft tissue, or complex, involving the phalanges. Additionally, syndactyly can be categorized as complete, involving the entire digit (including the nail fold), or incomplete, which does not involve the nail fold. Multiple familial or spontaneous genetic abnormalities can cause syndactyly, and these mutations typically involve the canonical wingless-type (WNT) pathway. Surgical repair of syndactyly is typically done between six to 18 months of age, depending on the type of syndactyly. Regardless of the classification of the syndactyly, the repair is performed before school-going age (except in the case of extremely mild or rare, extremely complex syndactyly). One or more imaging modalities are used to aid the surgeon in deciding the surgical approach for the syndactyly repair. The surgical plan must be clearly communicated with parents to manage expectations of aesthetics and function of the digits post-surgery. In brief, a syndactyly release surgery involves the creation of the web space using a geometrical design of the surgeon's choice, defatting of finger flaps, separation of the digits, and closure with absorbable sutures. However, the approach may vary depending on the patient. A "best" approach for rectifying the difference in surface area of separated versus fused digits has not yet been determined. While this was typically done using a skin graft, the use of alternative methods (most notably, using a synthetic dermal substitute or not using a graft at all and allowing the skin to heal with secondary intention) has been on the rise given the undesirable side effects of a graft. Less commonly, an external fixator can be used to expand soft tissue and skin. In the case of complete syndactyly, the Buck-Gramcko technique is most commonly used for nail flap reconstruction. Complications of the surgery include contracture, web creep, and the need for a second surgery. Thus, parents must be counseled in recognizing signs of complications.
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Affiliation(s)
- Sonal Mahindroo
- Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sean Tabaie
- Orthopedic Surgery, Children's National Hospital, Washington DC, USA
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Li J, Wang Q, Panayi AC, Wu M, Tang X, Hong P, Ze R. Novel Use of Pennig External Fixation for the Treatment of Pediatric Syndactyly. Tech Hand Up Extrem Surg 2021; 25:245-250. [PMID: 33654022 PMCID: PMC8601664 DOI: 10.1097/bth.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Syndactyly is one of the most common congenital limb malformations, second only to polydactyly. Syndactyly is treated with surgical intervention. During separation, free skin grafting or skin flap transplantation is required to allow for adequate skin closure. We introduce a novel application method of the Pennig external fixation device for the management of pediatric syndactyly without skin grafting. The Pennig minifixator was used in syndactyly to expand the web space soft tissue in order to allow a Z-plasty to be performed in a second operation. All patients had developed sufficient skin tissue from the external fixation. No infection, cutaneous necrosis or nonunion was noted in any of the patients. All patients had a satisfactory outcome in terms of final appearance and digit function. On the basis of the principle of strain-stress, use of the Penning external minifixator allows development of sufficient tissue in the web space for a second phase of reconstruction in syndactyly. The need for skin grafting and risk of blood vessel damage were avoided in this study, and, the incidence of skin necrosis and scar formation was reduced. Both the patients' families and our research members expressed high satisfaction with the postoperative function and appearance. Overall, application of the Pennig external fixation frame in our novel method is effective for the management of syndactyly and should be studied further. Level of Evidence: Level IV, case series.
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Affiliation(s)
- Jin Li
- Departments of Orthopedics
| | - Qin Wang
- Geriatrics, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei
| | - Adriana C. Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Mengfan Wu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Cui Y, Xu Q, Wang J, Lin J, Liu B, Wang G, Sun Y, Pei Y, Zhang H, Zhu L. Application of external fixator traction in the treatment of syndactyly. J Orthop Translat 2020. [DOI: 10.1016/j.jot.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Le Hanneur M, Cambon-Binder A, Bachy M, Fitoussi F. Treatment of congenital syndactyly. HAND SURGERY & REHABILITATION 2020; 39:143-153. [PMID: 32142954 DOI: 10.1016/j.hansur.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 10/24/2022]
Abstract
Defined as the union of two adjacent digits, syndactyly is one of the most common congenital deformities. The severity of the malformation depends on the fusion level, the tissues involved in the union, and whether it is isolated or syndromic. In order to improve the hand's appearance and function, surgery is recommended in the great majority of cases, ideally during early childhood (i.e., before entering school). Web space reconstruction is done using local flaps. Depending on the flap design, digital resurfacing can be done with or without skin grafts. While graftless techniques have shorter operating times and no morbidity associated with skin harvesting, their cosmetic outcomes seem to be worse than those of traditional grafting techniques, with more postoperative complications; furthermore, such techniques cannot be used in all cases, especially those with osteoarticular fusions. When the fingertip is involved, paronychial reconstruction is carried out with pulp flaps. The prognosis for these deformities directly depends on their severity, with excellent outcomes in cases of cutaneous fusion, and much less predictable ones when osteoarticular and/or tendinous tissues are involved.
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Affiliation(s)
- M Le Hanneur
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - A Cambon-Binder
- Service of Hand Surgery, Department of Orthopedics and Traumatology, Saint-Antoine Hospital, Sorbonne University, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - M Bachy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
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Mende K, Watson A, Stewart DA. Surgical Treatment and Outcomes of Syndactyly: A Systematic Review. J Hand Surg Asian Pac Vol 2020; 25:1-12. [DOI: 10.1142/s2424835520300017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Different techniques are used to release simple and complex congenital syndactyly in order to create an adequate web space, and to separate the fingers to allow independent function. Methods: This article is a systematic review of the literature, aiming to evaluate the evidence for the different techniques and outcome measures utilised. Results: The studies consisted mainly of retrospective, non-controlled descriptive series and a few retrospective cohort studies. The level of evidence is predominantly poor. Conclusions: Although recommendations in favour of any particular surgical technique cannot be given based on evidence, a number of conclusions can be drawn out of the existing literature with regards to the design of the incisions for finger separation, use of pulp flaps and grafts.
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Affiliation(s)
- Konrad Mende
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, The Children’s Hospital at Westmead, Sydney Medical School (University of Sydney), Sydney, Australia
| | - Anna Watson
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, The Children’s Hospital at Westmead, Sydney Medical School (University of Sydney), Sydney, Australia
| | - David A. Stewart
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, The Children’s Hospital at Westmead, Sydney Medical School (University of Sydney), Sydney, Australia
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Progress in surgical strategies for treatment of simple congenital syndactyly: A systematic review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Phalangeal Lengthening Techniques for Brachydactily and Posttraumatic Digital Stumps With the Use of a Modified External Mini-Fixator. Tech Hand Up Extrem Surg 2017; 20:61-6. [PMID: 27043289 DOI: 10.1097/bth.0000000000000116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Distraction osteogenesis has become the most used method for bone lengthening and deformity correction including the bones of the hand and foot. The principle techniques used for hand bone lengthening in posttraumatic and congenital conditions using available external fixators are based on this method. We present the technical specifications and surgical techniques with the use of a mini-fixator that was specially designed for short tubular bones. The surgical techniques of lengthening and web space skin stock creation for future web-pasty are supplied with the diagrams of their application to phalanges and illustrative clinical cases. Between 1999 and 2012, this mini-fixator was used for lengthening of 223 finger segments at our hospital and provided improvement of the hand esthetics and functions.
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Contribution of G.A. Ilizarov to bone reconstruction: historical achievements and state of the art. Strategies Trauma Limb Reconstr 2016; 11:145-152. [PMID: 27432154 PMCID: PMC5069200 DOI: 10.1007/s11751-016-0261-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/09/2016] [Indexed: 02/07/2023] Open
Abstract
Methodological solutions of Prof. G.A. Ilizarov are the core stone of the contemporary bone lengthening and reconstruction surgery. They have been acknowledged in the orthopaedic world as one of the greatest contributions to treating bone pathologies. The Ilizarov method of transosseous compression–distraction osteosynthesis has been widely used for managing bone non-union and defects, bone infection, congenital and posttraumatic limb length discrepancies, hand and foot disorders. The optimal conditions for implementing distraction and compression osteogenesis were proven by numerous experimental studies that Prof. G.A. Ilizarov organized and supervised at a large orthopaedic research institute in Kurgan. The tension stress effect on regeneration and growth of tissues was thoroughly investigated with radiographic, histological and biochemical methods. The impact of the Ilizarov method on the progress of bone lengthening and reconstruction surgery could be called revolutionary.
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Lohmeyer JA, Hülsemann W, Mann M, Habenicht R. Transverse soft tissue distraction preceding separation of complex syndactylies. J Hand Surg Eur Vol 2016; 41:308-14. [PMID: 26497594 DOI: 10.1177/1753193415612380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 07/10/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Various surgical techniques are described for separation of syndactylies leading to good results. However, the use of standard techniques is limited in complex syndactylies with extensive bony fusion and tight soft tissues. The aim of this study was to assess the outcomes of a two-stage procedure involving progressive soft tissue distraction prior to syndactyly release. Between 1996 and 2012 we treated 168 complex syndactylies with this technique. The main indications were syndactylies in Apert syndrome. The digits were distracted through an external fixator at 0.5 mm/day. Distraction of 15-25 mm was achieved. Soft tissue distraction provided additional skin, a wider nail matrix and more bone in the form of callus. Thus subsequent modelling of the fingertips was improved, especially if they were closely fused. This technique facilitates treatment of complex cases and improves aesthetic outcome. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- J A Lohmeyer
- Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany Department of Plastic Surgery, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany Department of Plastic Surgery and Hand Surgery, Technische Universität München, Munich, Germany
| | - W Hülsemann
- Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - M Mann
- Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - R Habenicht
- Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
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Gitlin D, Malezhik V, Georgiev KG. Tissue Expansion Technique for Desyndactylization of Toes Using an External Fixator. J Foot Ankle Surg 2016; 55:1069-71. [PMID: 26860041 DOI: 10.1053/j.jfas.2016.01.010] [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: 07/17/2015] [Indexed: 02/03/2023]
Abstract
We present an alternative technique for desyndactylization of toes using soft tissue traction with an external fixator. This method allows for tissue expansion for subsequent skin plasty, thereby avoiding the need for a graft or complicated local skin rearrangement. The use of the conventional acute correction technique can create more scarring and might increase the potential for complications, especially if the graft is obtained from a remote site. We believe that this technique provides a satisfactory functional and cosmetic outcome. This method has the potential to minimize postoperative complications, provide functional digits, and allow for good cosmetic results.
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Affiliation(s)
- David Gitlin
- Podiatry Residency Director, Department of Orthopedic Surgery, Mount Sinai Beth Israel, New York, NY
| | - Vera Malezhik
- Department of Orthopedic Surgery, Mount Sinai Beth Israel, New York, NY.
| | - Krum G Georgiev
- Department of Orthopedic Surgery, Mount Sinai Beth Israel, New York, NY
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Abstract
To introduce a new external fixation device for the management of syndactyly in children. To evaluate its preliminary clinical result. From January 2011 to June 2012, 12 cases with cutaneous syndactyly of the middle/ring finger were managed with a new external fixator designed by our department. There were eight cases on the right side and four on the left side. The web space and soft tissue were stretched gradually using the new device. A Z-plasty of syndactylies was performed when the web space has reached the width that we required. The results were evaluated according to the clinical appearance and function of the fingers. Twelve cases had been followed up, with an average time of 16 months (range, 12-27 months). The web space and soft tissue in all the cases were stretched successfully using the new device. Skin grafting was not necessary in the reconstruction of syndactyly. In the last follow-up, the Vancouver Score averaged 0.6 (range, 0-2). Three cases had grade 1 web creep, whereas the other nine cases had grade 0 web creep. The total active motion averaged 130.4° for all affected fingers: 130.8° for the middle and 130.0° for the ring finger. Stiffness in the PIP joint preoperatively in two cases did not improve postoperatively. In 12 affected middle fingers, three cases had a supination deformity averaging 10.6° (range, 5°-15°) and one case had a pronation deformity of 5°. In 12 affected ring fingers, one case had a supination deformity of 18° and two cases had a pronation deformity averaging 7.5° (range, 5°-10°). The middle finger was not pronated in any patient. Among all the ring fingers, two had radial deviation of 8°and 25° and 1 had ulnar deviation of 10°. The surgeon-provided visual analog scale score for esthetics averaged 1.8 (range, 0-5). The parent-provided visual analog scale score was 2.7 (range, 1-5) for pain, 1.3 (range, 0-5) for appearance, and 1.3 (range, 0-5) for function. Displacement of the nail bed during distraction was found in two cases, which was resolved by the Winograd technique in the second surgery of syndactyly release. The clinical appearance and function were excellent. When we use the new external fixation device in the management of syndactyly, we can achieve a satisfactory outcome with little scar of the fingers. There was no need for skin grafting. However, the long-term result should be studied further.
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Cortez M, Fernandes Júnior JV, da Silva RF, Gilbert A, Valenti P, Brandt CT, Teles AAP. Surgical results from treating children with syndactyly through the collective effort system at "SOS Hand Recife" between 2005 and 2009. Rev Bras Ortop 2014; 49:396-400. [PMID: 26229834 PMCID: PMC4511606 DOI: 10.1016/j.rboe.2014.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 08/27/2012] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE to evaluate the results from and parents' satisfaction with treatment for children with syndactyly who were operated at the "SOS Hand Recife" hospital between 2005 and 2009. METHODS data for assessing the results were gathered from the patients' medical files. The subjective scores, which were ascertained prospectively, were as follows: greater than or equal to 9, good result; between 6 and 8, fair result; less than 6, poor result. The results were analyzed statistically. This study was approved by the institution's ethics committee. RESULTS among the 35 cases, 21 (60%) consisted of simple syndactyly and 14 (40%) were complex; 22 (62.8%) were boys and 13 (37.1%) were girls. The complex cases were predominantly among males. The main complications were infection (11.4%), bleeding (11.4%) and pain (8.6%). There were more complications in the complex cases (42.8%) than in the simple cases (33.3%). The mean scores from the parents' subjective evaluations were as follows: 7.6 for esthetics (7.7 in simple cases and 7.3 in complex cases; 8.2 for function (8.6 in simple cases and 7.6 in complex cases); 8.3 for the parents' general satisfaction level (8.6 in simple cases and 8.0 in complex cases); and 85.7% of the parents would recommend the surgery to others while 14.5% would not. A strong association was observed between the specialist's objective assessment and the scores given by the parents (p < 0.05). CONCLUSION the surgical results from treating syndactyly presented differences between the simple and complex types, even though the parents' esthetic evaluations and satisfaction were similar.
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Affiliation(s)
- Mauri Cortez
- Hospital SOS Mão Recife, Universidade Federal de Pernambuco, Recife, PE, Brazil ; Cirurgia da Mão, Hospital SOS Mão Recife, Recife, PE, Brazil
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Cortez M, Fernandes Júnior JV, Silva RFD, Gilbert A, Valenti P, Brandt CT, Teles AAP. Resultados cirúrgicos do tratamento de crianças portadoras de sindactilia operadas em sistema de mutirão no SOS Mão Recife entre 2005 e 2009. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2012.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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França Bisneto EN. Congenital deformities of the upper limbs. Part II: failure of formation and duplications. Rev Bras Ortop 2013; 48:3-10. [PMID: 31304103 PMCID: PMC6565893 DOI: 10.1016/j.rboe.2012.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 10/02/2012] [Indexed: 11/30/2022] Open
Abstract
This article, presented in three sections, review the most common upper limb malformations and their treatments. In this section two there's a discussion about failure of formation and duplication of the parts. The bibliography is continuous since section one.
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Affiliation(s)
- Edgard Novaes França Bisneto
- Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, Hospital das Clinicas, School of Medicine, Universidade de São Paulo; Care Association for Disabled Children of São Paulo (AACD), São Paulo, SP, Brazil
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Deformidades congênitas dos membros superiores. Parte II: falhas de formação e duplicação. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Soft tissue distraction in hand surgery: the "pentagonal frame" technique. Strategies Trauma Limb Reconstr 2009; 4:19-25. [PMID: 19319651 PMCID: PMC2666827 DOI: 10.1007/s11751-009-0055-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 03/08/2009] [Indexed: 11/03/2022] Open
Abstract
Soft tissue distraction (STD) is an increasingly accepted operation in all fields of hand surgery from elbow contracture release to PIP joint release. Current techniques reported lack the ability to distract the joints of the fingers or the hand, maintain the length of released contractures, and hold them in a position while active and passive physiotherapy is possible. We describe a technique by which STD of the hand and fingers is done with no joint or tendon involvement overcoming the aforementioned drawbacks. Thirty-three patients with hand contractures were treated. In this method, a thin 1–1.5-mm Kirschner wire was passed horizontally at the proximal head of the distal phalanx and bent like a frame around the finger, forming a pentagonal shape for anchorage. The distal distraction was exerted at the distal phalanx. Various forms of external fixation were then used to distract a finger, several fingers, or the hand by placing tension on this frame; the distraction was either static (with a wire exerting pressure) or dynamic (using a rubber band to adjust the tension). After obtaining the desired result, the wire or rubber band was temporarily freed to commence active and passive physiotherapy. We maintained the frame for 3–6 weeks. All 33 patients were successfully treated. No major complications were encountered during the follow-up period (3–5 years). The pentagonal frame allows for effective distraction of soft tissues and joint ligaments and maintains the space needed for healing of fractures of the metacarpals and phalanges.
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Agarwal A. Comment on Shevtsov and Danilkin: Application of external fixation for management of hand syndactyly. INTERNATIONAL ORTHOPAEDICS 2008; 33:581. [PMID: 18629496 DOI: 10.1007/s00264-008-0620-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 06/16/2008] [Indexed: 11/25/2022]
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