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Reliability and validity of Vancouver Scar Scale and Withey score after syndactyly release. J Pediatr Orthop B 2022; 31:603-607. [PMID: 35502746 DOI: 10.1097/bpb.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to analyze the reliability and validity of the Vancouver Scar Scale (VSS) and the Withey score after syndactyly release. Over a 3-year period, 13 patients who underwent syndactyly release were evaluated. The mean age at the time of syndactyly release was 12 months (range, 8-18 months), and the mean follow-up period was 29 months (range, 17-52 months). We obtained hand photographs and finger motion videos and collected the satisfaction scores for hand function and cosmesis. Three clinicians evaluated the hand photographs and finger motion video of each patient twice using the VSS and the Withey score. The interobserver and intraobserver reliabilities of the VSS and Withey score were determined using intraclass correlation coefficients (ICCs). The validity of the VSS and Withey score was determined using Spearman's correlation test with the functional and cosmetic satisfaction score. The ICCs for the interobserver reliability of VSS were 0.31 and 0.39 for each measurement, and ICCs for the intraobserver reliability of VSS were 0.46, 0.51, and 0.54 for each observer. The ICCs for the interobserver reliability of the Withey score were 0.74 and 0.70, and the ICCs for the intraobserver reliability of the Withey score were 0.91, 0.74, and 0.96. The Withey score was significantly correlated with the satisfaction score for hand function and hand cosmesis, but the VSS was not. The VSS had poor interobserver reliability and fair intraobserver reliability, whereas the Withey score had good interobserver reliability and excellent intraobserver reliability based on photographic evaluation after syndactyly release.
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Bruyere A, Delord M, Vernet P, Loréa P, Gicquel P, Clavert JM, Schneider L, Moutet F, Sauleau E, Forli A, Facca S. Separation of congenital embryonic syndactylies in children: dorsal or volar flap? About a comparative retrospective series. Acta Orthop Belg 2022; 88:589-598. [PMID: 36791714 DOI: 10.52628/88.3.7914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Congenital syndactylies account for 1 to 2 out of 2000 birth defects. Although several types of syndactylies exist, we only studied embryonic syndactylies. The goal of our study was to compare 2 types of coverage flap for the reconstruction of the finger web spaces: a volar flap described by Blauth and a dorsal flap described by Gilbert. Between 1993 and 2015, children affected by simple and complex syndactylies (partial or complete) were treated in 2 french pediatric hospitals and were selected for our analytic, comparative, retrospective review. The 2 hospitals used different surgical techniques: one used a volar flap described by Blauth and the other a dorsal flap described by Gilbert. The children were followed up to look for signs according to the stages of the Classification of Withey and to evaluate a global result according to the score of Withey. Our secondary criteria of judgement were the aspect of the surgical scar according to the VSS (Vancouver Scar Scale) and the satisfaction of the parents and children. The age of the children, need for a surgical revision and time of last follow- up were also studied. We found statistically significant differences between group I (volar flap) and group II (dorsal flap) in favor of the volar flap: higher scores of Withey (even when the number of commissures was increasing) and better VSS (regardless of the number of web spaces treated). There was no statistically significant difference between the 2 groups in terms of age, follow-up, or rate of surgical revision. All in all, the volar flap presented less sequelae in terms of scar retraction. Regardless of the flap used, the cosmetic results of the full-thickness skin graft used impacted the result both on the receiving site (dyschromia, hairiness) and the donor site.
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Langlais T, Rougereau G, Marty-Diloy T, Bachy M, Barret H, Vialle R, Fitoussi F. Surgical treatment in child's congenital toe syndactyly: Risk factor of recurrence, complication and poor clinical outcomes. Foot Ankle Surg 2022; 28:107-113. [PMID: 33642221 DOI: 10.1016/j.fas.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/31/2020] [Accepted: 02/11/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Surgical treatment of toe syndactyly remains controversial. The strong demand from parents for a cosmetic release is increasing in our societies. But is it worth it? The objective was to assess medium-long term outcomes and to identify the risk factors of recurrence, complication and poor clinical outcomes. METHODS Sixty-eight toe syndactylies (38 patients) undergoing surgery between 2008 and 2017 with a follow-up higher than two years were included consecutively and retrospectively. Four children (four syndactylies) were lost to follow-up and excluded. The mean age of the first surgery was 3.9 years old (0.8-16.7) and cohort mean follow-up was 6.9 years (2.8-11.2). In all patients, web release with a commissural dorsal flap was performed and associated a cutaneous resurfacing (spontaneous epithelialization, full-thickness skin graft taken from the popliteal crease, or a hyaluronic acid ester matrix). RESULTS Eighteen syndactylies (28.1%) in 14 patients recurred and one syndactyly required revision surgery. An age of surgery above two years was the only risk factor for recurrence found in univariate (OD = 0.27[0.08;0.85];p = 0.02) and multivariate studies (IC 95% = 0.05-0.68;p = 0.02). Seven complications (11.7%) in seven syndactylies (6 patients) were reported with six keloids (9.4%) and one scar retraction (1.6%). Each complication underwent an additional procedure. African ethnicity (N = 15) represents a risk factor (N = 4/15; OD = 0.12[0.009;0.97];p = 0.02) for keloids formation. Withey's average score is 4.9 (1-11), mean OxAFQ-C score was 52/60 (30-60), 67% would repeat the surgery and 69% felt satisfied at last follow-up. The simple syndactyly would appear less satisfied than complex or complicated (p = 0.02). CONCLUSIONS Surgical treatment of child's congenital syndactyly involves a risk of recurrence (28%) and potential complications (11,7%). Performed surgical procedure over two years old increase the risk of recurrence. African ethnicity is a risk factor in scarring complication. Only half of simple syndactylies are satisfied and prone to repeat the surgery.
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Affiliation(s)
- Tristan Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; Children's Hospital, Purpan, Toulouse University, Toulouse, France.
| | - Gregoire Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Manon Bachy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Hugo Barret
- Orthopedics Department, Purpan, Toulouse University, Toulouse, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
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New Simple Technique for Syndactyly Release. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2842. [PMID: 33133902 PMCID: PMC7572197 DOI: 10.1097/gox.0000000000002842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/20/2020] [Indexed: 11/26/2022]
Abstract
Can good functional and cosmetic result be achieved in syndactyly separation using a straight midline incision with a hexagonal dorsal skin flap?
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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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Artuso M, Mas V, Ilharreborde B, Mazda K, Jehanno P. External fixation: Role in decreasing postoperative complications of complex syndactyly release - A review of 18 patients. Orthop Traumatol Surg Res 2019; 105:1187-1191. [PMID: 31353234 DOI: 10.1016/j.otsr.2019.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 04/16/2019] [Accepted: 05/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary and revision surgery for complete complex congenital syndactyly (CCCS) of the hand carries a risk of complications such as web maceration, which can result in flap or graft loss and alter the final appearance. No consensus emerges from the scant published data on postoperative care after CCCS surgery. The objective of this study was to assess the role for temporary external fixation in stabilising the commissure and facilitating surgical wound care. HYPOTHESIS Using external fixation after CCCS release facilitates postoperative wound care and decreases the complication rate. MATERIAL AND METHODS Eighteen patients requiring primary CCCS surgery or revision CCCS surgery due to adhesions or web creep were included in a single-centre retrospective study. After release, an external fixator made of Kirschner pins was installed to temporarily immobilise the inter-phalangeal joints. The dressing was changed every 3 days for 3 weeks, and the external fixator was then removed. The parents and nurses completed questionnaires that used 0-10 point scales to assess ease and duration of dressing changes and perceptions and apprehensions experienced by parents and nurses, as well as pain by patients, during dressing changes. RESULTS No patient experienced maceration or failure of a graft or flap. Pin site discharge was noted in 1 patient and resolved fully after pin removal. Pain intensity was estimated at 4.2/10 during the first dressing change and 1.3/10 during the last dressing change. In the parents, apprehension was 9.6/10 and 5.1/10 during the first and last dressing changes, and stress was 8.1/10 and 4.1/10, respectively. Dressing change difficulty was rated 1.1/10 at the first and 0.9/10 at the last dressing change. Dressing change duration decreased from 13 to 10minutes. CONCLUSION These encouraging results support temporary commissure stabilisation by an external fixator to decrease postoperative complication rates and facilitate dressing changes after CCCS release. LEVEL OF EVIDENCE IV, retrospective observational study.
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Affiliation(s)
- Mickaël Artuso
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, Bd Sérurier, 75019 Paris, France.
| | - Virginie Mas
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, Bd Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, Bd Sérurier, 75019 Paris, France
| | - Keyvan Mazda
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, Bd Sérurier, 75019 Paris, France
| | - Pascal Jehanno
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, Bd Sérurier, 75019 Paris, France
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Wang AA, Hutchinson DT. Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient. J Hand Surg Eur Vol 2019; 44:845-849. [PMID: 31096828 DOI: 10.1177/1753193419848989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7-166). The mean follow-up was 52 months (range 6-111). The mean tourniquet time was 97 minutes (range 66-135) for graft and 84 minutes (55-120) for graftless. The mean finger abduction was 57° (32°-80°) for graft and 54° (38°-80°) for graftless. The mean web creep score was 1.2 (0-3) for graft and 2.1 (0-3) for graftless. The mean scar score was 1.9 (1-3) bilaterally. The mean parents' visual analogue scale for graft cosmesis was 7.1 (5-9) and 6.2 (4.3-8) for graftless. The surgeon's visual analogue scale for graft was 7.9 (6.4-9.5) and 6.2 (4-8.7) for graftless. The therapist's visual analogue scale was 7.9 (6.5-10) and 6.4 (4.7-8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II.
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Affiliation(s)
- Angela A Wang
- Orthopedics, University of Utah, Salt Lake City, UT, USA
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Delord M, Forli A, Aribert M, Moutet F, Corcella D. [Results of Blauth Palmar Flap in congenital syndactyly: Long-term outcome in a 31 webs study]. ANN CHIR PLAST ESTH 2019; 65:204-212. [PMID: 31178308 DOI: 10.1016/j.anplas.2019.05.006] [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: 03/26/2019] [Accepted: 05/15/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The main purpose of our study was to assess the web creep rate of congenital syndactyly treated with a Blauth palmar commissural flap. METHODS Every child with at least one syndactyly, simple or complex, syndromic or not, were included in this study. The main criterion of this study was the web creep rate according to the Withey scale (0 to 4). Scar assessment according to the Vancouver Scar Scale, hair growth and/or dyschromia on the full-thickness graft, digital spacing, flexion deformity, clinodactyly, range of motion of the finger, sensitivity and satisfaction were also assessed. RESULTS Separation of the webbed fingers was performed in 65 syndactylies between 1993 and 2015. The median age at the time of surgery was 14 months. We reviewed 31 web flaps with a mean follow-up time of 9 years. Fifty eight percent of the webs were grade 0 on the Withey scale, 36% were grade 1, 6% were grade 2. There was no grade 3 or 4. No correlation was found between the age at the time of surgery, gender, web space involved, complexity of the syndactyly, and the web creep. A decrease in range of motion and a flexion deformity of the fingers involved were more frequently found in complex syndactylies. Eighty seven percent of full-thickness grafts presented dyschromia, and 42% abnormal pilosity. CONCLUSION Palmar flap as described by Blauth is a safe technique ensuring good functionals outcomes and a low web creep rate for the reconstruction of the web space in congenital syndactyly.
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Affiliation(s)
- M Delord
- SOS main Grenoble, unité de chirurgie réparatrice, de la main et des brûlés, hôpital A.-Michallon, CHU de Grenoble, avenue du Marquis-de-Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - A Forli
- SOS main Grenoble, unité de chirurgie réparatrice, de la main et des brûlés, hôpital A.-Michallon, CHU de Grenoble, avenue du Marquis-de-Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - M Aribert
- SOS main Grenoble, unité de chirurgie réparatrice, de la main et des brûlés, hôpital A.-Michallon, CHU de Grenoble, avenue du Marquis-de-Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - F Moutet
- SOS main Grenoble, unité de chirurgie réparatrice, de la main et des brûlés, hôpital A.-Michallon, CHU de Grenoble, avenue du Marquis-de-Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - D Corcella
- SOS main Grenoble, unité de chirurgie réparatrice, de la main et des brûlés, hôpital A.-Michallon, CHU de Grenoble, avenue du Marquis-de-Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
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Interdigitating Rectangular Flaps and Dorsal Pentagonal Island Flap for Syndactyly Release. J Hand Surg Am 2019; 44:288-295. [PMID: 30947823 DOI: 10.1016/j.jhsa.2019.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 12/05/2018] [Accepted: 01/25/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Interdigitating triangular flaps is the most commonly described technique for syndactyly release. However, triangular flaps may be associated with flap misalignment, flap tip necrosis, and a steep learning curve in design and technique. This study describes a series of syndactyly reconstructions using interdigitating rectangular flaps in both simple and complex syndactyly. METHODS A single surgeon's experience of syndactyly reconstruction using interdigitating rectangular flaps was reviewed retrospectively. Patient demographics, associated syndromes, operative technique, complications, and recurrences were analyzed. RESULTS Ninety-four web spaces in 50 children with 16 simple incomplete, 36 simple complete, 14 complex, 26 complicated, and 2 unclassified syndactylies were reconstructed with interdigitating rectangular flaps. Seventy-eight commissures were reconstructed with a dorsal pentagonal island flap and 16 with a dorsal rhomboid flap. Full-thickness skin grafts were used in 98% of webs. Five major complications required surgical intervention-2 recurrences, 2 web space scarrings, and 1 wound infection. Ten minor complications occurred-skin graft donor site dehiscence (3), partial loss of the skin graft (4), minor distal interphalangeal joint flexion contractures (2), and a case of minor web creep (1). Average follow-up was 13.7 months. All parents were satisfied with the function and appearance of their child's reconstructed digits. CONCLUSIONS Interdigitating rectangular flaps provide an effective technique for release of both simple and complex syndactyly. Advantages include easy learning owing to the relative simplicity of design; intraoperative modification of flap design (cut as you go), and wide flap tips, which prevent flap tip necrosis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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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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Canizares MF, Feldman L, Miller PE, Waters PM, Bae DS. Complications and Cost of Syndactyly Reconstruction in the United States: Analysis of the Pediatric Health Information System. Hand (N Y) 2017; 12. [PMID: 28644945 PMCID: PMC5484441 DOI: 10.1177/1558944716668816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Syndactyly is one of the most common congenital differences of the upper extremity and offers an exceptional opportunity to evaluate value-based care in pediatric orthopedic surgery. We designed a study to characterize complications and cost associated to syndactyly surgery among US pediatric hospitals. METHODS A total of 2047 patients were identified for syndactyly surgery at 38 pediatric hospitals from 2009 to 2012 using the Pediatric Health Information System (PHIS) database. We examined costs as well as complication rates across hospitals stratified by patient and hospital variables. RESULTS The postoperative complication rate was 1.9% (95% confidence interval [CI]: 1.3%-2.5%). Postoperative infection rate was 1.6% and surgical complication rate was 0.3%. Median adjusted standardized cost was $4112.5 (interquartile range: $2979-$6049). Patients with more than 1 diagnosis had 19 times higher risk of complications and were associated with 13% more hospital cost than those with syndactyly as single diagnosis ( P < .001). Finally, there was a wide variation in cost across hospitals; 8 (21%) yielded confidence limits above the benchmarked value. CONCLUSIONS In the United States, it is important to recognize variations in practice of syndactyly surgery in hopes of developing quality improvement strategies in pediatric orthopedic surgery.
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Affiliation(s)
| | | | | | | | - Donald S. Bae
- Boston Children’s Hospital, MA, USA,Donald S. Bae, Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Abstract
The results of 144 congenital syndactyly releases over a 12-year period by a single surgeon using a modified Flatt technique (dorsal hourglass flap, interdigitating zigzag flaps, and full-thickness skin grafts) are analyzed considering the association of skin grafts and web creep. The mean follow-up was 5 years. There were seven cases of graft failure, only one of which developed web creep. Web creep occurred in 4.2% of web releases. The results suggest that avoiding longitudinal straight-line scars across the web space may be an important factor in avoiding web creep when performing the modified Flatt technique described.
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Affiliation(s)
- A G Barabás
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
| | - M A Pickford
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
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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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