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Wall LB, Goldfarb CA. Syndactyly Reconstruction Technique Utilizing Skin Substitute. Tech Hand Up Extrem Surg 2024; 28:60-61. [PMID: 38385451 DOI: 10.1097/bth.0000000000000473] [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: 02/23/2024]
Abstract
Syndactyly reconstruction often times leaves areas of skin deficit that require coverage for healing. Numerous techniques have been reported to address the deficits, including graftless technique, which utilizes mobilization of adjacent skin for coverage, full-thickness skin grafting, and skin substitute grafts. The technique described here demonstrates the ease of the use of skin substitutes for coverage in syndactyly reconstruction and reports the expected outcomes.
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Affiliation(s)
- Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
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2
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Fangxing A, Gongchi L, Zhiwei L, Hanling L, Haiding Z, Yuxiong W, Jianghai C. Syndactyly release with the use of the Pelnac™ artificial dermal substitute without skin grafting. J Plast Reconstr Aesthet Surg 2023; 84:115-120. [PMID: 37329744 DOI: 10.1016/j.bjps.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/21/2023] [Accepted: 05/15/2023] [Indexed: 06/19/2023]
Abstract
We present our results of one-stage resurfacing following syndactyly release with the Pelnac™ artificial dermal substitute. From 2016 to 2020, raw areas after digit release were restored with an artificial dermal substitute in 145 webs from 62 patients (average age, 33.1 months) including 65 simple incomplete web spaces, 29 simple complete web spaces, 20 complex complete web spaces, and 31 complex complicated web spaces. Fourteen patients were syndromic. The average follow-up period was 33.4 months (range, 7-55 months). Postoperative outcomes assessed as according to the Vancouver scar scale (0-14) averaged 1.8 (range, 0-11) and web creep score (0-5) averaged 0.7 (range, 0-4). Patient- and family-provided visual analog scale scores averaged 1.1 (range, 0-10) for appearance. In conclusion, the Pelnac™ artificial dermal substitute is a minimally invasive, simple, and effective option for one-stage resurfacing of defects in syndactyly release.
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Affiliation(s)
- Ai Fangxing
- Department of Hand Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Jiefang Ave 1277, Wuhan, Hubei 430022, PR China
| | - Li Gongchi
- Department of Hand Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Jiefang Ave 1277, Wuhan, Hubei 430022, PR China
| | - Liu Zhiwei
- Department of Hand Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Jiefang Ave 1277, Wuhan, Hubei 430022, PR China
| | - Liu Hanling
- Department of Hand Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Jiefang Ave 1277, Wuhan, Hubei 430022, PR China
| | - Zhou Haiding
- Department of Hand Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Jiefang Ave 1277, Wuhan, Hubei 430022, PR China
| | - Weng Yuxiong
- Department of Hand Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Jiefang Ave 1277, Wuhan, Hubei 430022, PR China.
| | - Chen Jianghai
- Department of Hand Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Jiefang Ave 1277, Wuhan, Hubei 430022, PR China.
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Elfawy LA, Ng CY, Amirrah IN, Mazlan Z, Wen APY, Fadilah NIM, Maarof M, Lokanathan Y, Fauzi MB. Sustainable Approach of Functional Biomaterials-Tissue Engineering for Skin Burn Treatment: A Comprehensive Review. Pharmaceuticals (Basel) 2023; 16:ph16050701. [PMID: 37242483 DOI: 10.3390/ph16050701] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Burns are a widespread global public health traumatic injury affecting many people worldwide. Non-fatal burn injuries are a leading cause of morbidity, resulting in prolonged hospitalization, disfigurement, and disability, often with resulting stigma and rejection. The treatment of burns is aimed at controlling pain, removing dead tissue, preventing infection, reducing scarring risk, and tissue regeneration. Traditional burn wound treatment methods include the use of synthetic materials such as petroleum-based ointments and plastic films. However, these materials can be associated with negative environmental impacts and may not be biocompatible with the human body. Tissue engineering has emerged as a promising approach to treating burns, and sustainable biomaterials have been developed as an alternative treatment option. Green biomaterials such as collagen, cellulose, chitosan, and others are biocompatible, biodegradable, environment-friendly, and cost-effective, which reduces the environmental impact of their production and disposal. They are effective in promoting wound healing and reducing the risk of infection and have other benefits such as reducing inflammation and promoting angiogenesis. This comprehensive review focuses on the use of multifunctional green biomaterials that have the potential to revolutionize the way we treat skin burns, promoting faster and more efficient healing while minimizing scarring and tissue damage.
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Affiliation(s)
- Loai A Elfawy
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Chiew Yong Ng
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ibrahim N Amirrah
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Zawani Mazlan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Adzim Poh Yuen Wen
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nur Izzah Md Fadilah
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Manira Maarof
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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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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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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6
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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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Baldelli I, Baccarani A, Barone C, Bedeschi F, Bianca S, Calabrese O, Castori M, Catena N, Corain M, Costanzo S, Barbato GDP, De Stefano S, Divizia MT, Feletti F, Formica M, Lando M, Lerone M, Lorenzetti F, Martinoli C, Mellini L, Nava MB, Porcellini G, Puliti A, Romanini MV, Rondoni F, Santi P, Sartini S, Senes F, Spada L, Tarani L, Valle M, Venturino C, Zaottini F, Torre M, Crimi M. Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence). Orphanet J Rare Dis 2020; 15:201. [PMID: 32758259 PMCID: PMC7405453 DOI: 10.1186/s13023-020-01481-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background Poland syndrome (OMIM: 173800) is a disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, breast, shoulder, arm, and hand. The extent and severity of the abnormalities vary among affected individuals. Main body The aim of this work is to provide recommendations for the diagnosis and management of people affected by Poland syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years affected subjects. The literature search was performed in the second half of 2019. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus. Conclusion Being Poland syndrome a rare syndrome most recommendations here presented are good clinical practice based on the consensus of the participant experts.
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Affiliation(s)
- Ilaria Baldelli
- Policlinico San Martino Hospital IRCCS for Oncology, Genoa, Italy.,Associazione Italiana Sindrome Poland, Via Asiago, 3r, 16137, Genoa, Italy
| | - Alessio Baccarani
- Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, Modena, Italy
| | - Chiara Barone
- Medical Genetics, Referral Centre for Rare Genetic Diseases, ARNAS Garibaldi, Catania, Italy
| | - Francesca Bedeschi
- Clinical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sebastiano Bianca
- Medical Genetics, Referral Centre for Rare Genetic Diseases, ARNAS Garibaldi, Catania, Italy
| | - Olga Calabrese
- Medical Genetic Unit, University Hospital of Modena, Modena, Italy
| | - Marco Castori
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Nunzio Catena
- Pediatric Orthopedic and Traumatology Unit Azienda Ospedalieria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Massimo Corain
- Hand Surgery Unit - Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Costanzo
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Santa De Stefano
- Associazione Italiana Sindrome Poland, Via Asiago, 3r, 16137, Genoa, Italy
| | | | - Francesco Feletti
- Department of Diagnostic Imaging AUSL of Romagna, U.O. of Radiology, "Santa Maria delle Croci" Civil Hospital, Ravenna, Italy
| | - Matteo Formica
- Orthopedic Clinic, Department of Surgical Sciences, University of Genova, Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Lando
- Department of Muscle-Skeletal Surgery, Hand and Microsurgery Division, Modena University Hospital, Modena, Italy
| | - Margherita Lerone
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Fulvio Lorenzetti
- Plastic and Reconstructive Surgery Unit, University of Pisa, Santa Chiara Hospital, Pisa, Italy
| | - Carlo Martinoli
- Department of Health Science, Section of Radiology, University of Genoa, Genoa, Italy
| | - Lorenzo Mellini
- Associazione Italiana Sindrome Poland, Via Asiago, 3r, 16137, Genoa, Italy.,Department of Morphology Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Maurizio Bruno Nava
- G.Re.T.A. Group for Reconstructive and Therapeutic Advancements, University of Genoa, Genoa, Italy
| | - Giuseppe Porcellini
- Department of Orthopaedics and Traumatology, Modena Policlinic, Modena, Italy
| | - Aldamaria Puliti
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,DiNOGMI, University of Genova, Genoa, Italy
| | - Maria Victoria Romanini
- Plastic and Reconstructive Surgery, Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Franco Rondoni
- USL Umbria 1, Ospedale Città di Castello, Perugia, Italy
| | - Pierluigi Santi
- Policlinico San Martino Hospital IRCCS for Oncology, Genoa, Italy.,Associazione Italiana Sindrome Poland, Via Asiago, 3r, 16137, Genoa, Italy
| | - Silvana Sartini
- Hand Rehabilitation Center, Modena University Hospital, Modena, Italy
| | - Filippo Senes
- Reconstructive Surgery and Hand Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lucia Spada
- Centro di Educazione Matrimoniale e Prematrimoniale, Genoa, Italy
| | - Luigi Tarani
- Department of Pediatrics, "Sapienza", University of Rome, Rome, Italy
| | - Maura Valle
- UOC Radiologia Neuroradiologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Federico Zaottini
- Department of Health Science, Section of Radiology, University of Genoa, Genoa, Italy
| | - Michele Torre
- Associazione Italiana Sindrome Poland, Via Asiago, 3r, 16137, Genoa, Italy.,Pediatric Thoracic and Airway Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Crimi
- Associazione Italiana Sindrome Poland, Via Asiago, 3r, 16137, Genoa, Italy. .,Kaleidos SCS-Onlus, Scientific Office, Bergamo, Italy.
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Wall LB, Velicki K, Roberts S, Goldfarb CA. Outcomes of Pediatric Syndactyly Repair Using Synthetic Dermal Substitute. J Hand Surg Am 2020; 45:773.e1-773.e6. [PMID: 32061463 DOI: 10.1016/j.jhsa.2019.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 11/01/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Full-thickness skin grafts are classically used for areas of skin deficit in syndactyly reconstruction surgery. However, skin grafting requires additional time under anesthesia and includes donor site morbidity. Synthetic dermal substitute has produced favorable web creep and scar appearance outcomes in syndactyly reconstruction. We sought to validate these results using objective outcome measures. METHODS All patients who had undergone syndactyly reconstruction with synthetic dermal substitute with 1-year follow-up were identified. We included 23 webs in 16 patients; 2 were lost to follow-up. Median age at surgery was 27 months; 7 patients were female. Five webs were revision surgeries. Two patients had a diagnosis of amniotic constriction band, and 3 had symbrachydactyly. All webs were assessed from blinded clinical photos. Outcome measures included web creep assessment (range, 0-5) and Vancouver Scar Scale. RESULTS Of 21 webs, 2 had minimal creep and 16 had none; 3 had clinically relevant creep (grade 2). Vancouver Scar Scale scores for all webs averaged 1.19 (0 is normal). There was normal vascularity in 20 webs, pigmentation was normal in 17 webs, skin pliability was normal in 13 webs, and scar height was flat in 15 webs. On the visual analog scale assessment, surgeons rated the appearance of the 21 webs as an average of 8.8 (range, 5-10). There were no postoperative complications. CONCLUSIONS Synthetic dermal substitute is an effective, efficient, and visually satisfactory option for coverage of skin deficits in syndactyly reconstruction. The current heterogeneous sample revealed that this approach can provide satisfactory outcomes for patients, families, and surgeons. Although no surgical complications were noted, the rate of integration and healing has yet to be determined. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
| | - Katherine Velicki
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Summer Roberts
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
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Kozusko SD, Hassouba M, Hill DM, Liu X, Dadireddy K, Velamuri SR. Esterified Hyaluronic Acid Matrix in Lower Extremity Reconstruction With Exposed Tendon and Bone: A Retrospective Review. J Burn Care Res 2020; 41:828-834. [PMID: 32303758 PMCID: PMC7333675 DOI: 10.1093/jbcr/iraa044] [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] [Indexed: 11/25/2022]
Abstract
Lower extremity wounds with exposed bone and tendon often need coverage to allow the underlying tissue to regenerate prior to skin graft. The surgeon is limited in his or her choices to augment tissue regeneration in these types of complicated cases; for instance, autologous skin should not be placed on exposed bone or tendon and is at risk for contracture when placed over the joints. Therefore, novel technologies are necessary to provide a scaffolding for tissue to regenerate and allow for a successful graft. One such technology is an esterified hyaluronic acid matrix (eHAM), which can provide a proper scaffold for endothelial cell migration and aid in angiogenesis. The eHAM is made of two layers: a layer of hyaluronic acid covered with a silicone layer. In this retrospective chart review, we describe our usage of eHAM to provide scaffolding for tissue regeneration prior to grafting in 15 cases of complicated lower extremity wounds with exposed bone and tendon. The average patient age was 45.8 years, and all patients had multiple medical comorbidities, such as poorly controlled diabetes mellitus, hypertension, and nicotine addiction. Patient wound types were diverse, including traumatic wounds, chronic diabetic foot ulcers, and thermal or electric burns. Thirteen of the 15 cases were treated successfully with eHAM. In these cases, definitive coverage with split-thickness skin grafting was effective and limb salvage was successful. In the 13 successful cases, the mean time to split-thickness skin graft was 22.9 ± 7.0 days. All patients continue to do well at follow-up (ranging from 6 to 48 weeks), with minimal complications reported. Given the success rate with eHAM in this challenging population, we conclude that eHAM can be a treatment option for similar cases.
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Affiliation(s)
- Steven D Kozusko
- Division of Plastic Surgery, Cooper University Hospital, Camden, New Jersey
| | - Mahmoud Hassouba
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis
| | - David M Hill
- University of Tennessee Health Science Center, Memphis; Firefighters' Regional Burn Center, Memphis, Tennessee
| | - Xiangxia Liu
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis
| | - Kalyan Dadireddy
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis
| | - Sai R Velamuri
- University of Tennessee Health Science Center, Memphis; Firefighters' Regional Burn Center, Memphis, Tennessee
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10
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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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11
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Matecka M, Lelonkiewicz M, Pieczyńska A, Pawlaczyk M. Subjective Evaluation of the Results of Injectable Hyaluronic Acid Fillers for the Face. Clin Interv Aging 2020; 15:39-45. [PMID: 32021131 PMCID: PMC6968800 DOI: 10.2147/cia.s233405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background Skin ageing is a physiological process, progressive and irreversible. Hyaluronic acid injection treatments are used to correct the signs of skin ageing. Material and Methods Hyaluronic acid was implanted in the area of the cheek and the forehead aesthetic units in 57 women, aged 35-55 years. Apart from the clinical observation, self-assessment of the therapeutic results was conducted. The "My skin" questionnaire was used for subjective evaluation of the treatment results. Results Mean wrinkle score in the pre-menopausal group changed after the treatment, from 3.2±0.6 to 1.1±0.3 and from 3.2±0.6 to 0.8±0.6 for the forehead and the cheek esthetic units, respectively. In the post-menopausal group, the score decreased from 3.8±0.4 to 1.7± 0.7 and from 3.2±0.617 to 0.8± 0.6 for the forehead and the cheek esthetic units, respectively. The changes were age-dependent. Improved appearance of the facial skin - higher satisfaction with skin tone and scent - was reported after hyaluronic acid injections. Higher subjective perception of improvement corresponded to older age, irrespectively of the menopausal status. Correlations between age and the effect of the treatment on maintaining proper skin hydration as well as between improved appearance of the forehead area and feelings of autonomy and well-being were found. Conclusion Hyaluronic acid injections significantly improved the subjective perception and overall assessment of the scent and appearance of the facial skin.
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Affiliation(s)
- Monika Matecka
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Anna Pieczyńska
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariola Pawlaczyk
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
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12
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Simple Syndactyly Release With Dental Roll Dressing. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Hayes AJ, Melrose J. Glycosaminoglycan and Proteoglycan Biotherapeutics in Articular Cartilage Protection and Repair Strategies: Novel Approaches to Visco‐supplementation in Orthobiologics. ADVANCED THERAPEUTICS 2019. [DOI: 10.1002/adtp.201900034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Anthony J. Hayes
- Bioimaging Research HubCardiff School of BiosciencesCardiff University Cardiff CF10 3AX Wales UK
| | - James Melrose
- Graduate School of Biomedical EngineeringUNSW Sydney Sydney NSW 2052 Australia
- Raymond Purves Bone and Joint Research LaboratoriesKolling Institute of Medical ResearchRoyal North Shore Hospital and The Faculty of Medicine and HealthUniversity of Sydney St. Leonards NSW 2065 Australia
- Sydney Medical SchoolNorthernRoyal North Shore HospitalSydney University St. Leonards NSW 2065 Australia
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14
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Chocarro-Wrona C, López-Ruiz E, Perán M, Gálvez-Martín P, Marchal JA. Therapeutic strategies for skin regeneration based on biomedical substitutes. J Eur Acad Dermatol Venereol 2019; 33:484-496. [PMID: 30520159 DOI: 10.1111/jdv.15391] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/09/2018] [Indexed: 12/16/2022]
Abstract
Regenerative medicine and tissue engineering (TE) have experienced significant advances in the development of in vitro engineered skin substitutes, either for replacement of lost tissue in skin injuries or for the generation of in vitro human skin models to research. However, currently available skin substitutes present different limitations such as expensive costs, abnormal skin microstructure and engraftment failure. Given these limitations, new technologies, based on advanced therapies and regenerative medicine, have been applied to develop skin substitutes with several pharmaceutical applications that include injectable cell suspensions, cell-spray devices, sheets or 3Dscaffolds for skin tissue regeneration and others. Clinical practice for skin injuries has evolved to incorporate these innovative applications to facilitate wound healing, improve the barrier function of the skin, prevent infections, manage pain and even to ameliorate long-term aesthetic results. In this article, we review current commercially available skin substitutes for clinical use, as well as the latest advances in biomedical and pharmaceutical applications used to design advanced therapies and medical products for wound healing and skin regeneration. We highlight the current progress in clinical trials for wound healing as well as the new technologies that are being developed and hold the potential to generate skin substitutes such as 3D bioprinting-based strategies.
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Affiliation(s)
- C Chocarro-Wrona
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain.,Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, Granada, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain.,Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, Spain
| | - E López-Ruiz
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain.,Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, Granada, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain.,Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, Spain.,Department of Health Sciences, University of Jaén, Jaén, Spain
| | - M Perán
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, Granada, Spain.,Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, Spain.,Department of Health Sciences, University of Jaén, Jaén, Spain
| | - P Gálvez-Martín
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Granada, Granada, Spain.,Advanced Therapies Area, Bioibérica S.A.U., Barcelona, Spain
| | - J A Marchal
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain.,Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, Granada, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain.,Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, Spain
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15
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Simman R, Hermans MHE. Managing Wounds with Exposed Bone and Tendon with an Esterified Hyaluronic Acid Matrix (eHAM): A Literature Review and Personal Experience. J Am Coll Clin Wound Spec 2018; 9:1-9. [PMID: 30591894 DOI: 10.1016/j.jccw.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The loss of extracellular matrix in combination with the exposure of structures such as bone and tendon pose a major challenge; the development of granulation tissue and subsequent reepithelialization over these structures is extremely slow and often may not happen at all. Replacement of the matrix has been shown to significantly increase the chances of healing since, with revascularization of the matrix, a wound bed is created that may either heal by secondary intention or via the application of a skin graft. A literature search on an esterified hyaluronic acid-based matrix (eHAM) returned five articles on the treatment of wounds with tendon and bone loss in which the eHAM was used. The etiologies of the wounds described varied among the articles, as did treatment modalities. However, all of them received proper debridement of necrosis with subsequent (although not always immediately) application of the eHAM. A very high percentage of all wounds reached the different primary endpoints in the studies, which were complete reepithelialization, complete coverage with granulation tissue and/or 10% coverage of the original wound size with epithelium, the latter being a strong indicator of the wound continuing to heal. The individual authors concluded that the esterified hyaluronic acid matrix (eHAM) is a valuable tool to assist in the complete healing of difficult to heal wounds.
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Affiliation(s)
- Richard Simman
- Dermatology, Wright State University School of Medicine, Dayton, OH, United States.,Clinical Professor of Surgery, University of Toledo College of Medicine, United States
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16
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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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17
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Dong Y, Wang Y. The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment: A STROBE compliant study. Medicine (Baltimore) 2017; 96:e7639. [PMID: 28746226 PMCID: PMC5627852 DOI: 10.1097/md.0000000000007639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Numerous techniques have been developed that use various flaps to treat syndactyly. Skin grafts have often been used to cover remaining surgical defects. The long-term aim of surgery is to find new methods of separating the digits without using skin grafts. This paper describes a new surgical technique for the correction of simple, incomplete, and complete syndactyly. The technique consists of a dorsal double-wing flap to cover the newly created web space and zigzag incisions in the fingers, thus avoiding the use of skin grafts in this space. Overall, 35 web spaces in 24 patients were treated using this technique. Patient follow-up ranged from 6 months to nearly 5 years. There were no complications such as hematoma, infection or flap necrosis, and no fingers needed skin grafts after separation. The average operative time for each web space was approximately 45 minutes. Ninety-seven percent of patients treated with the dorsal double-wing flap procedure achieved good function, and superior cosmetic results following a single surgery. The technique is simple, rapid, safe, and easily performed and does not require the use of skin grafts.
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Affiliation(s)
- Yanzhao Dong
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University
- Department of Orthopedics, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yisheng Wang
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University
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18
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Widerberg A, Sommerstein K, Dahlin LB, Rosberg HE. Long-term results of syndactyly correction by the trilobed flap technique focusing on hand function and quality of life. J Hand Surg Eur Vol 2016; 41:315-21. [PMID: 26546604 DOI: 10.1177/1753193415613724] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/25/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Syndactyly is usually corrected surgically during the first years of life. The trilobed flap, a surgical method that does not require skin grafting, was developed in the 1990s and the short-term results were comparable with previously reported techniques. Here we report on long-term outcomes, focusing on how children perceive their hand function and quality of life when they grow up. A total of 19 patients (29 web spaces) were operated on between 1990 and 2000, and followed-up 16 years later with questionnaires and clinical tests. The patients reported low QuickDASH scores, normal sensibility and dexterity, and minor cold intolerance. Only two reoperations, due to early web creep, were needed. The condition minimally affected the choice of occupations, leisure activities and perceptions of appearance. The trilobed flap technique for release of syndactyly provides a good long-term outcome with good hand function and minimal impact on the quality of life. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A Widerberg
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - K Sommerstein
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - L B Dahlin
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden Department of Translational Medicine, Lund University, Malmö, Sweden
| | - H-E Rosberg
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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19
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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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20
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Ichihara S, Vaiss L, Acciaro AL, Facca S, Liverneaux P. External bone remodeling after injectable calcium-phosphate cement in benign bone tumor: two cases in the hand. Orthop Traumatol Surg Res 2015; 101:983-6. [PMID: 26545943 DOI: 10.1016/j.otsr.2015.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 07/08/2015] [Accepted: 09/03/2015] [Indexed: 02/02/2023]
Abstract
Bone remodeling commonly occurred after fracture and curettage benign bone tumor. A lot of previous articles reported "internal" trabecular bone remodeling. There were no previous clinical reports about "external" cortical bone remodeling. We present here 2 clinical cases of "external" bone remodeling after injectable calcium-phosphate in benign bone tumor in the hand. In two cases of benign bone tumor, we performed complete removal of the tumor and immediate filling of the metacarpal bone with injectable calcium-phosphate cement Arexbone(®) from the mechanical viewpoint. With respect to the shape of the calcium-phosphate, by using an injection-type, calcium-phosphate is adhered uniformly to the bone cortex by injecting, remodeling has been promoted. After 5 and 8years, both cases were no recurrences, and the shape of the metacarpal looked close to the contralateral side. These findings supposed to be concerned with potential self-healing and self-protection mechanism in human body.
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Affiliation(s)
- S Ichihara
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France; Orthopedic Surgery Department, Juntendo University, Tokyo, Japan
| | - L Vaiss
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | | | - S Facca
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - P Liverneaux
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France.
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21
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Hynes SL, Harvey I, Thomas K, Copeland J, Borschel GH. CT angiography-guided single-stage release of adjacent webspaces in non-Apert syndactyly. J Hand Surg Eur Vol 2015; 40:625-32. [PMID: 25005563 DOI: 10.1177/1753193414541222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/31/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED We describe the CT angiography protocol and surgical technique utilized at our institution for single-stage release of adjacent web-spaces in non-Apert syndactyly. In a series of seven consecutive hands we analyse syndactyly anatomy, CT angiographic findings, operative details, and complications. Outcomes were assessed with a functional activity evaluation, range of motion, and a parental visual analogue scale. Seven affected hands in four patients underwent single-stage release of adjacent webspaces. In all cases, the CT angiogram correctly predicted the presence of at least one artery supplying each digit. There were no cases of digital ischemia or loss. Angiographically guided, single-stage release of adjacent webspaces is technically feasible and benefits patients by reducing the number of surgical stages and allowing complete release to be achieved at an earlier age compared with the standard multi-stage approach. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S L Hynes
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - I Harvey
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - K Thomas
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Copeland
- Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - G H Borschel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Deng H, Tan T. Advances in the Molecular Genetics of Non-syndromic Syndactyly. Curr Genomics 2015; 16:183-93. [PMID: 26069458 PMCID: PMC4460222 DOI: 10.2174/1389202916666150317233103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/18/2015] [Accepted: 03/16/2015] [Indexed: 12/16/2022] Open
Abstract
Syndactyly, webbing of adjacent digits with or without bony fusion, is one of the most common hereditary limb malformations. It occurs either as an isolated abnormality or as a component of more than 300 syndromic anomalies. There are currently nine types of phenotypically diverse nonsyndromic syndactyly. Non-syndromic syndactyly is usually inherited as an autosomal dominant trait, although the more severe presenting types and subtypes may show autosomal recessive or X-linked pattern of inheritance. The phenotype appears to be not only caused by a main gene, but also dependant on genetic background and subsequent signaling pathways involved in limb formation. So far, the principal genes identified to be involved in congenital syndactyly are mainly involved in the zone of polarizing activity and sonic hedgehog pathway. This review summarizes the recent progress made in the molecular genetics, including known genes and loci responsible for non-syndromic syndactyly, and the signaling pathways those genetic factors involved in, as well as clinical features and animal models. We hope our review will contribute to the understanding of underlying pathogenesis of this complicated disorder and have implication on genetic counseling.
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Affiliation(s)
- Hao Deng
- Center for Experimental Medicine ; Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Ting Tan
- Center for Experimental Medicine
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