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Bartsch A, Nikkhah D, Miller R, Mende K, Hovius SER, Kaempfen A. Correction of symbrachydactyly: a systematic review of surgical options. Syst Rev 2023; 12:218. [PMID: 37974291 PMCID: PMC10652478 DOI: 10.1186/s13643-023-02362-7] [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: 02/28/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
Symbrachydactyly is a rare congenital malformation of the hand characterized by short or even absent fingers with or without syndactyly, mostly unilaterally present. The hand condition can vary from a small hand to only nubbins on the distal forearm. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes.The review was performed according to the PRISMA guidelines. Literature was systematically assessed searching the Cochrane Library, PubMed, Embase, and PROSPERO databases up to January 1, 2023. Studies were identified using synonyms for 'symbrachydactyly' and 'treatment'. Inclusion criteria were the report of outcomes after surgical treatment of symbrachydactyly in humans. Studies were excluded if they were written in another language than English, German, or French. Case reports, letters to the editor, studies on animals, cadaveric, in vitro studies, biomechanical reports, surgical technique description, and papers discussing traumatic or oncologic cases were excluded.Twenty-four studies published were included with 539 patients (1037 digit corrections). Only one study included and compared two surgical techniques. The quality of the included studies was assessed using the Modified Coleman Methodology Score and ranged from 25 to 47. The range of motion was the main reported outcome and demonstrated modest results in all surgical techniques. The report on aesthetics of the hand was limited in non-vascularized transfers to 2/8 studies and in vascularized transfers to 5/8 studies, both reporting satisfactory results. On average, there was a foot donor site complication rate of 22% in non-vascularized transfers, compared to 2% in vascularized transfers. The hand-related complication rate of 54% was much higher in the vascularized group than in the non-vascularized transfer with 16%.No uniform strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates, with the vascularized transfer showing relative high hand-related complications and the non-vascularized transfer showing relative high foot-related complications.There were no high-quality studies, and due to a lack of comparing studies, the data could only be analysed qualitatively. Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactyly due to inadequate study designs and comparative studies. This systematic review was registered at the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews number: CRD42020153590 and received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Level of evidenceI.Systematic review registrationPROSPERO CRD42020153590.
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Affiliation(s)
- A Bartsch
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland
- Orthopaedic Surgery and Traumatology, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland
| | - D Nikkhah
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust, London, UK
| | - R Miller
- Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT5, UK
| | - K Mende
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland
| | - S E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A Kaempfen
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland.
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland.
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Thumb and first webspace reconstruction in nonsyndromic congenital mitten hand with symbrachydactyly. J Plast Reconstr Aesthet Surg 2022; 75:1902-1906. [PMID: 34972652 DOI: 10.1016/j.bjps.2021.11.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nonsyndromic congenital mitten hand with thumb and index finger syndactyly is rare. Reconstruction of this condition is challenging, requiring repositioning of the thumb and creation of a wide and deep first webspace. The aim of this paper is to describe the characteristics of patients with this condition and also to describe our surgical technique. METHODS We describe our technique in 16 consecutive children utilizing complete mobilization of the first metacarpal and thumb as an island flap on the neurovascular bundle, with a rotational osteotomy to reposition the thumb in pronation. In addition, a dorsal M flap was used to reconstruct the first webspace. Patients in this series also had varying degrees of symbrachydactyly with hypoplastic or aplastic phalanges of the central digits. RESULTS There were 9 male and 7 female patients, with a mean age of 24.4 ± 22.4 months at the time of surgery. Mean follow-up was 19.1 ± 18.3 months. All reconstructions healed well. The mean thumb web distance in the affected hands was 4.2 cm (range 3.5 to 5). All reconstructed thumbs had a good opposition. Two children initially had mild hypertrophic scarring, which resolved with pressure gloves. No other complications were observed. CONCLUSION One-stage reconstruction of the thumb and first webspace can be effectively achieved with our technique of complete mobilization of the thumb unit, rotational osteotomy, and a dorsal interdigitating M flap.
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Wu T, Walchak A, Rayan GM. Congenital Thumb-Index Web Space Deficiency. Hand (N Y) 2021; 16:50-56. [PMID: 30895820 PMCID: PMC7818023 DOI: 10.1177/1558944719837694] [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] [Indexed: 11/17/2022]
Abstract
Background: There are several congenital hand differences that cause thumb-index (TI) web space deficiency. There is a knowledge gap in the literature about the hand differences that are associated with TI web space deficiency. We aimed to identify these congenital differences and the various specific reconstructive surgical procedures that are used for these conditions. Methods: We conducted a retrospective chart review of children treated operatively over a period of 30 years for congenital TI web space deficiency by the senior author (G.M.R.). We gathered data on demographics and associated congenital hand differences and compiled a list of all surgical procedures performed for the web space and the ipsilateral upper extremity. Results: We included 71 patients (77 hands) with 12 congenital hand differences (62 developmental and 9 spastic). The total number of upper extremity operations, (ie), anesthetics performed for these patients was 186, averaging 2.6 settings and 7.5 procedures for each patient. Cutaneous reconstructive procedures included first dorsal metacarpal artery pedicle flaps (49 patients), 4-flap Z-plasties (15), and transposition flaps (13). In addition, 16 different thumb reconstructive procedures were necessary. Ten patients required revision of their TI web space procedures for recurrence. Conclusions: The prevalence of TI web space deficiency is underappreciated. These patients often have multiple musculoskeletal anomalies of the hand and upper extremity that should be ruled out and require surgical treatment to optimize hand function. Consideration should be given to performing more than one procedure in one setting when possible.
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Affiliation(s)
- Tiffany Wu
- The University of Oklahoma College of
Medicine, Oklahoma City, USA
| | - Adam Walchak
- The University of Oklahoma College of
Medicine, Oklahoma City, USA
| | - Ghazi M. Rayan
- INTEGRIS Baptist Medical Center,
Oklahoma City, Oklahoma, USA,Ghazi M. Rayan, INTEGRIS Baptist Medical
Center, Hand Surgery Division, 3366 NW Expressway Suite 700, Oklahoma City, OK
73112, USA and Department of Orthopedic Surgery & Rehabilitation University
of Oklahoma College of Medicine, 800 Stanton L Young Blvd, Suite 3400, Oklahoma
City, OK 73104, USA.
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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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Özdemir M, Kavak RP, Karacif O, Selek Y. Atypical cleft hand with complex syndactyly: An unusual form of hand oligodactyly. Radiol Case Rep 2019; 14:1407-1409. [PMID: 31695828 PMCID: PMC6823787 DOI: 10.1016/j.radcr.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022] Open
Abstract
Hand oligodactyly refers to a developmental defect which results in the presence of less than 5 digits on a hand. It presents as a component of 4 main categories of congenital upper limb malformations. Herein, we present a 50-year-old man with an unusual form of hand oligodactyly which is characterized by atypical cleft hand accompanied by complex syndactyly between the thumb and the index finger. Accurate characterization of hand oligodacticity can sometimes be challenging due to unusual phenotypic appearances accompanying the abnormality. Radiological evaluation is of great importance for correct identification and classification of such complex hand anomalies, and the treatment should be highly individualized in these patients.
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Affiliation(s)
- Meltem Özdemir
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
| | - Rasime Pelin Kavak
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
| | - Onur Karacif
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
| | - Yasin Selek
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
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Wang W, Wang B, Xu J, Bian Z, Yao J, Gong X, Zhang Y, Zhang H, Zhou S, Jiang Y, Zeng B, Chen J, Yao W, Zhang L, Zhu L, Chen Y, Ni F, Ding S, Lu L. Limb Dysdifferentiation. Plast Reconstr Surg 2017. [DOI: 10.1007/978-981-10-5101-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Background: Symbrachydactyly is a unilateral congenital hand malformation characterized by failure of formation of fingers and the presence of rudimentary digit nubbins. The management is variable and are investigated in this review. Methods: A detailed review of the literature was compiled into succinct clinically relevant categories. Results: Etiology, classification, non-surgical management, surgical intervention, and patient oriented outcomes are discussed. Conclusions: All interventions should prioritize realistic, evidence-supported appearance and functional gains. Studies of the baseline function and quality of life of children with symbrachydactyly would allow surgeons to better understand functional changes associated with various interventions and would help surgeons and parents to make the best treatment decisions.
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Affiliation(s)
| | - Andrea S. Bauer
- Shriners Hospital for Children Northern California, Sacramento, USA,Andrea S. Bauer, Boston Children’s Hospital 300 Longwood Avenue, HUN 213 Boston, MA 02115, USA.
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