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Cordray H, Graham EM, Kota A, Shah AS, Chang B, Mendenhall SD. Clinical and operative risk factors for complications after Apert hand syndactyly reconstruction. J Hand Surg Eur Vol 2024; 49:617-626. [PMID: 37987676 PMCID: PMC11044518 DOI: 10.1177/17531934231213516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
This study evaluated how Apert hand syndactyly presentations and reconstructive techniques influence reconstruction outcomes. All cases at a major paediatric hospital between 2007 and 2022 were analysed, including 98 web space reconstructions in 17 patients. Overall, 62% of hands developed complications and 15% required revision surgery. Upton hand type was significantly associated with postoperative complication incidence, specifically including range-of-motion deficits, flexion contracture, web creep and revision surgery. More severe syndactylies may benefit from additional measures to reduce complications. Rectangular commissural flaps showed 1.9 times greater complication risk than interdigitating triangular flaps, including 11.2 times greater risk of web creep. Zigzag volar finger flaps showed 1.8 times greater complication risk than straight-line incisions, including 3.8 times greater risk of web creep. Our study showed that interdigitating triangular commissural flaps and straight-line volar finger incisions are preferable to rectangular commissural and zigzag finger flaps in most cases of Apert hand syndactyly to minimize complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M. Graham
- Division of Plastic, Reconstructive, and Oral Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anchith Kota
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Apurva S. Shah
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin Chang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Plastic, Reconstructive, and Oral Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shaun D. Mendenhall
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Plastic, Reconstructive, and Oral Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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