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Cheng S, Gao W, Ding J, Zhou Z, Wang A. Efficacy of a fingertip reconstruction technique using the tongue-shaped flap and advancement flap for repairing congenital syndactyly with osseous fusion of the distal phalanges. J Plast Reconstr Aesthet Surg 2023; 81:1-6. [PMID: 37060893 DOI: 10.1016/j.bjps.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND To explore the clinical efficacy of using tongue-shaped flaps and advancement flaps to reconstruct the fingertips in congenital syndactyly patients with osseous fusion of the distal phalanges. METHODS From January 2016 to January 2019, 12 patients with congenital syndactyly, involving 30 digits in total, presented to our hospital and were surgically treated with tongue-shaped flaps, as well as with advancement flaps to reconstruct the fingertips. The flap infection rate, necrosis rate and any other early complications were recorded. Fingertip aesthetics were reported according to the modified Bulic scale. A questionnaire was used to assess the satisfaction of the patients' family members. RESULTS All cases were thoroughly reviewed. The postoperative period for inclusion in this study ranged from 36 to 60 months, with an average follow-up time of 45 months. During this period, no complications such as infection and/or necrosis of any flap were observed. Significant improvements in finger aesthetics and functioning compared to preoperative values were observed in most cases. Based on the modified Bulic scale, of 30 fingertips, an excellent result was obtained for 3, a very good result for 13, a good result for 13 and a poor result for just 1. Family members were satisfied with the treatment outcome. CONCLUSIONS This technique employing tongue-shaped flaps and advancement flaps to reconstruct fingertips is effective, which enables the attainment of favourable aesthetic and functional outcomes in congenital syndactyly patients with osseous fusion of the distal phalanges.
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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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Pei J, Zhang J, Song B. The use of abdominal flaps for complex syndactyly release: a case series. J Hand Surg Eur Vol 2021; 46:552-554. [PMID: 33423581 DOI: 10.1177/1753193420981842] [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: 02/03/2023]
Affiliation(s)
- Jiaomiao Pei
- Department of Plastic and Reconstructive Surgery, Xijing Hospital of Forth Military Medical University, Xi'an, People's Republic of China
| | - Juan Zhang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital of Forth Military Medical University, Xi'an, People's Republic of China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital of Forth Military Medical University, Xi'an, People's Republic of China
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Mayfield CK, Thomas I, Shauly O, Gould DJ, Seruya M. Validating Grading of Aesthetic Outcomes of Web Space Reconstruction for Finger Syndactyly: Crowdsourcing Public Perceptions Using Amazon Mechanical Turk. Aesthet Surg J Open Forum 2021; 3:ojaa046. [PMID: 33791667 PMCID: PMC7760566 DOI: 10.1093/asjof/ojaa046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It has recently been attempted in the literature to analyze the aesthetic outcomes of syndactyly web space reconstruction utilizing dorsal pentagonal advancement flaps and dorsal rectangular flaps with skin grafting. The study utilized a categorical grading system for evaluating the aesthetic outcomes of reconstruction to be used in conjunction with a visual analog scale (VAS), which has yet to be validated in the assessment of aesthetic outcomes following web space reconstruction. OBJECTIVES To utilize crowdsourced public perceptions to validate the grading of aesthetic outcomes in web space reconstruction for finger syndactyly. METHODS A prospective study was conducted of random volunteers recruited through an internet crowdsourcing service to gain responses for a survey to analyze patient opinions toward the aesthetic outcomes of web space reconstruction. Outcomes were graded based on descriptions of the appearance, color, matte, and distortion of the reconstruction. RESULTS The excellent dorsal flap demonstrated a mean VAS score of 6.66 (95% confidence interval [CI] = 6.45-6.87), and the very good, good, and poor dorsal flaps had mean VAS scores of 5.94 (95% CI = 5.73-6.15), 4.98 (95% CI = 4.77-5.19), and 3.55 (95% CI = 3.31-3.79), respectively. The odds ratio for receiving an excellent rating was 4.21 (95% CI = 3.04-5.82) for excellent dorsal flap with P < 0.0001. CONCLUSIONS This study confirms and validates the assessment of aesthetic outcomes of web space reconstruction by the Yuan Grading Scale. This evidence may guide future practice such that recommendations can be made to align with the aesthetic preferences of the patient.
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Affiliation(s)
- Cory K Mayfield
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ian Thomas
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mitchel Seruya
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 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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Swarup I, Zhang Y, Do H, Daluiski A. Epidemiology of syndactyly in New York State. World J Orthop 2019; 10:387-393. [PMID: 31840019 PMCID: PMC6908446 DOI: 10.5312/wjo.v10.i11.387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/22/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is paucity of literature focusing on the incidence and surgical management of syndactyly. In this study, we describe the incidence and rates of surgical management of patients with syndactyly in New York State.
AIM To describe the incidence and surgical management of patients with syndactyly using an America's population-based database.
METHODS We conducted a retrospective study using the New York State Statewide Planning and Research Cooperative System. All patients with a diagnosis of syndactyly at birth were identified and followed longitudinally to determine yearly incidence as well as demographic and surgical factors. Descriptive statistics and univariate analyses were used.
RESULTS There were 3306 newborns with a syndactyly diagnosis between 1997 and 2014 in New York State. The overall incidence was 0.074% or 7 cases per 10000 live births. A small number of patients underwent surgical correction in New York State (178 patients, 5.4%). Among the surgical patients, most of the operations were performed before the age of two (79%). Approximately 87% of surgeries were performed at teaching hospitals, and 52% of procedures were performed by plastic surgeons. Skin grafting was performed in 15% of cases. Patients having surgery in New York State were more likely to have Medicaid insurance compared to patients not having surgery (P = 0.02).
CONCLUSION Syndactyly occurs in approximately 7 per 10000 live births, and the majority of patients undergo surgical correction before age two. There may be several barriers to care including the availability of specialized hand surgeons, access to teaching hospitals, and insurance status.
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Affiliation(s)
- Ishaan Swarup
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Yi Zhang
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY 10021, United States
| | - Huong Do
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY 10021, United States
| | - Aaron Daluiski
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
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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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Aesthetic Comparison of Two Different Types of Web-Space Reconstruction for Finger Syndactyly. Plast Reconstr Surg 2019; 142:963-971. [PMID: 29994847 DOI: 10.1097/prs.0000000000004798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. The authors' study compares the long-term aesthetic outcomes of these two flap techniques. METHODS Forty-five patients were included in the authors' study. The methods of reconstruction used were a dorsally based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting. Eighteen independent raters completed a visual analogue scale and a unique classification scale to subjectively assess aesthetic outcomes. The authors used univariate analyses to determine which variables significantly influenced the outcome score. The authors then used multivariable regression models to compare the two flap types. RESULTS Dorsally based rectangular flaps with skin graft had statistically significantly better visual analogue scale scores and greater odds of receiving an "excellent" rating compared with dorsal pentagonal advancement flaps. CONCLUSIONS Despite the use of skin grafting, with its associated donor-site morbidity, dorsal rectangular flaps may offer better overall aesthetic outcomes for patients. Future comparative studies should incorporate functional and patient-reported outcomes to better assess the optimal reconstruction type. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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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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Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1203. [PMID: 28203504 PMCID: PMC5293302 DOI: 10.1097/gox.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 11/26/2022]
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A Systematic Review and Comparison of Outcomes Following Simple Syndactyly Reconstruction With Skin Grafts or a Dorsal Metacarpal Advancement Flap. J Hand Surg Am 2017; 42:34-40.e6. [PMID: 28052826 DOI: 10.1016/j.jhsa.2016.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/25/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Many techniques exist for simple syndactyly reconstruction. The most commonly used techniques involve either skin grafts or a dorsal metacarpal advancement flap. Our aim was to review and compare the outcomes of these 2 techniques systematically. METHODS We reviewed articles from PubMed, MEDLINE, EMBASE, and Google Scholar published between January 1966 and January 2016. We identified studies that reported outcomes after reconstruction of simple syndactyly using skin grafts and those using only a dorsal metacarpal advancement flap. Cases of complex syndactyly and those that were not clearly differentiated by technique or type of simple syndactyly were excluded. Outcomes were then stratified by technique and type of syndactyly (complete and incomplete). RESULTS We identified 693 articles and selected 34 for inclusion. No standardized outcome measure was uniformly applied in the examined studies. Overall, skin grafting procedures were associated with more complications (eg, flap necrosis/graft failure, contracture, web creep, hypertrophic scarring) and a greater need for revision. When stratified by subtype, patients with simple, complete syndactyly who underwent skin grafting had a significantly higher rate of hypertrophic scarring than those who underwent reconstruction with a dorsal metacarpal advancement flap. CONCLUSIONS Simple syndactyly reconstruction with a dorsal metacarpal advancement flap may lead to fewer complications than procedures using skin grafts. However, substantial limitations of currently available evidence do not allow for the recommendation of a specific technique. Future research should use a uniform reporting system for syndactyly classification and complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Abstract
Syndactyly is one of the most common congenital hand anomalies treated by pediatric plastic surgeons. Established principles of syndactyly separation dictate the timing and order of syndactyly release, with the goals of surgery being the creation of an anatomically normal webspace, tension-free closure of soft tissue, and return of function to the fingers. Numerous surgical methods have been described, many of which involve the use of local flaps to reconstruct the commissure and full-thickness skin grafts for coverage of raw areas. Recently, reconstructive techniques without the use of skin grafts have been devised, which work well for certain indications. Special considerations are described for complete, complex, and syndromic syndactylies. Outcomes for simple syndactyly release are typically good when surgical principles are followed, whereas complex syndactyly release tends to have less-favorable outcomes and more complications.
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Affiliation(s)
- Tara L Braun
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Trost
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Karamese M, Akdag O, Selimoglu MN, Unal Yıldıran G, Tosun Z. V-Y and rectangular flap combination for syndactyly repair. J Plast Surg Hand Surg 2015; 50:102-6. [PMID: 26541805 DOI: 10.3109/2000656x.2015.1106409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE For syndactyly repair, several delicate, well-planned flap combination techniques have been reported. This study presents technique details with functional and aesthetic results of a dorsal rectangular and volar V-Y advancement flap combination for web reconstruction and S incisions for finger separation in patients with syndactyly. METHOD Ten patients with 16 syndactyly webs were treated. Patients were examined in terms of function and aesthetic. Evaluation criteria included the Vancouver Scar Scale, range of motion, degree of web creeping, parent's satisfaction rates, and finger abduction. During the initial period, vascular compromise of fingers, haematoma, infection, seroma, flap necrosis, or graft failures were not noted in any patients. No patients required revision surgery. During the later period, parent satisfaction scores were excellent or good, finger function was complete, and the Vancouver Scar Scale showed that two webs had hyperpigmented areas and two had supple pliability. CONCLUSION This simple syndactyly release technique can provide a low rate of web creep, good scar quality, and optimal functional results.
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Affiliation(s)
- Mehtap Karamese
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
| | - Osman Akdag
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
| | - Muhammed Nebil Selimoglu
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
| | - Gokce Unal Yıldıran
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
| | - Zekeriya Tosun
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
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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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Sahin C, Ergun O, Kulahci Y, Sever C, Karagoz H, Ulkur E. Bilobed flap for web reconstruction in adult syndactyly release: a new technique that can avoid the use of skin graft. J Plast Reconstr Aesthet Surg 2014; 67:815-21. [PMID: 24559731 DOI: 10.1016/j.bjps.2014.01.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Abstract
AIM The aim of the study was to describe the use of a bilobed flap for web formation of syndactyly release, which decreases the need for graft and also avoids the use of skin grafting in syndactyly cases. METHODS A retrospective review of this procedure was performed for 15 web space reconstructions. Patients were aged 20-23 years. The mean follow-up period was 7-12 months (mean 7 + 3.2). The operations were performed for the beneficial use of the dorsal hand skin by lowering the need for a skin graft. The flap was on the dorsum of the hand and proximal phalanx and was used for web formation. RESULTS Surgery was completed without skin grafting in nine cases of 14 web spaces; two of them were complex/complete syndactylies, and two of them were simple/complete syndactylies. We used a skin graft in one patient because of triangular flap necrosis in a second operation. The use of a bilobed flap allowed the construction of web spaces, providing satisfactory cosmetic outcomes. No partial necrosis or complications was observed in bilobed flaps. No secondary correction was needed during the follow-up period. CONCLUSION The present surgical technique could be a new surgical option for web formation and reconstruction in primary and secondary cases, especially in an adult population in which the skin on the dorsum of the hand is more pliable. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cihan Sahin
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Istanbul, Turkey.
| | | | - Yalcin Kulahci
- Gulhane Military Medical Academy, Department of Hand and Upper Extremity Surgery, Ankara, Turkey
| | - Celalettin Sever
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Istanbul, Turkey
| | - Huseyin Karagoz
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Istanbul, Turkey
| | - Ersin Ulkur
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Istanbul, Turkey
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Abstract
An aesthetically pleasing fingertip is an important but often under evaluated goal in syndactyly release. We assessed the aesthetic fingertip outcome in 26 patients with complete syndactylies, with a total of 84 separated digits, using a four-grade scale based on the quality of the lateral nail fold, nail plate definition, symmetry and pulp fullness. Fingertips with complete simple syndactylies released with the use of full-thickness skin grafts achieved a significantly better aesthetic result then fingertips with complete complex syndactylies released with the use of Buck-Gramcko pulp flaps. Fingertips involved in complex syndactylies achieved significantly better aesthetic results when reconstructed using Buck-Gramcko flaps in comparison with those reconstructed with full-thickness skin grafts. We recommend the use of Buck-Gramcko flaps in complete complex syndactylies, while reserve the traditional zig-zag and full-thickness skin graft closure for cases of complete simple syndactylies. We also propose a grading system for the aesthetic outcome of the fingertip following syndactyly release.
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Affiliation(s)
- K Bulic
- Department of Plastic Surgery, University Hospital Zagreb, Zagreb, Croatia.
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20
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Goldfarb CA, Steffen JA, Stutz CM. Complex syndactyly: aesthetic and objective outcomes. J Hand Surg Am 2012; 37:2068-73. [PMID: 22939825 DOI: 10.1016/j.jhsa.2012.06.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/26/2012] [Accepted: 06/27/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Outcome data after the treatment of complex syndactyly are lacking. The purpose of this investigation was to critically analyze and report our results after surgical reconstruction of complex syndactyly. METHODS We included 13 patients and 21 hands (25 webspaces) in this retrospective call-back investigation. There were 17 middle/ring finger and 8 ring/little finger complex syndactylies, each with a defined, isolated osseous bridge between the distal phalanges. We excluded complicated and syndrome-associated syndactylies. Patients returned for clinical examination and subjective assessment at an average of 9 years (range, 2-27 y) after the most recent surgery. Of 21 hands, 6 had undergone a revision surgery. RESULTS The Vancouver Scar Scale scores averaged 3 (range, 0-6), web creep averaged 1.5 (range, 0-3), and total active motion averaged 148° for the affected fingers. In the middle/ring finger syndactylies, the middle finger was most commonly supinated (average, 13°) and ulnarly deviated (average, 9°), and the ring finger was either supinated or pronated and radially deviated (average, 13°). In the ring/little finger syndactylies, the ring finger was most commonly supinated (average, 8°) without deviation, and the little finger was most commonly pronated (average, 8°) and radially deviated (average, 24°). There was a notable nail wall deformity in most fingers. Surgeon visual analog scale scores (range, 0-10, where lower scores are better) averaged 2.8 (range, 0.8-5.0). Patient visual analog scale scores were 0.4 (range, 0-3) for pain, 1.9 (range, 0-10) for appearance, and 1.1 (range, 0-3) for function. CONCLUSIONS Complex syndactyly reconstruction is challenging, and common postsurgical findings include rotational and angular deformity and nail deformity. When deformity was present, the fingers typically rotated away from and deviated toward the site of the previous complex syndactyly. We describe how we have altered our approach based on these findings. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA.
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