ABSTRACT
Objective: To discuss the effectiveness of using dorsal two wing-shaped advancement flap to reconstruct finger web for treatment of congenital syndactyly. Methods: Between August 2014 and August 2017, 30 cases of congenital syndactyly were treated, including 18 males and 12 females with an average age of 2.5 years (range, 1.5-5 years). Eight cases were of bilateral hands syndactyly and 22 cases of single hand syndactyly. There were 39 webs of syndactyly (including 1 case of syndactyly of middle finger, ring finger, and little finger). Among them, 11 webs were complete and 28 webs were incomplete. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle was designed and was just sewed up with an anchor-shaped incision at the palm. Distal end of fingers were separated by serrated flap and were sutured after removal of fatty tissue. In 11 cases with tight skin connection, the defect area at lateral and distal end of fingers was repaired by small pieces of full-thickness skin graft. Results: All the flaps survived completely after operation, and no flap necrosis occurred. The skin grafts on the distal side of the finger survived and the wound healed by first intension. All 30 cases were followed up 6-12 months, with an average of 9 months. Postoperative flexion and extension function of fingers were good, and the web depth and width were normal. At last follow-up, according to the Swanson et al. standard, 20 fingers were graded as excellent, 8 as good, and 2 as fair, with an excellent and good rate of 93.3%. Conclusion: The effectiveness of using dorsal two wing-shaped advancement flap to reconstruction finger web for treatment of congenital syndactyly is satisfactory.
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Objective@#To analyze the vascular distribution of palmar digital arteries in congenital syndactyly through CT angiography and its significance for operation design.@*Methods@#From January 2012 to May 2016, 67 cases with congenital syndactyly were divided into simple, complex and syndrome type(Poland syndrome). Preoperative angiography was performed to reconstruct 3-D distribution of digital arteries.@*Results@#33 cases with 48 pairs simple syndactyly had relatively normal distribution and diameter of digital arteries, but the 7 case with 11 pairs complex syndactyly had only one palmar digital artery in 4 pairs, and two arteries in 4 pairs with decreased arteries diameter. 25 cases with Poland syndrome and 66 pairs of snydactyly had normal distribution of digital arteries with relatively small diameter.@*Conclusions@#Angiography is not necessary for simple type syndactyly, but should be performed in patients with III and IV Poland syndrome and complex type to analyze the vascular distribution within the syndactyly and give help for operative design.
ABSTRACT
Introdução: A sindactilia é uma anomalia congênita comum da mão, tem incidência de aproximadamente um em 2.000 nascimentos, predomínio no sexo masculino e é bilateral em 50% dos casos. Objetivo é descrever uma série de casos de pacientes com sindactilia nas mãos, operados no Hospital Sarah Brasília, com a técnica de Skoog modificada e o uso de órtese. Métodos: Realizou-se a técnica de Skoog modificada para correção de sindactilia. No pós-operatório, foi confeccionada órtese punho-mão e dedos, e procedeu-se à avaliação do resultado da cicatriz conforme a Escala de Vancouver. Resultado: Durante cinco anos, avaliaram-se 45 pacientes, sendo 30 (66%) homens e 15 mulheres, com idade de um a quatro anos (média de dois anos - 60%), 37% dos casos mostraram-se associados a síndromes, 50% eram simples e bilateral. As complicações observadas nas sindactilias simples foram encontradas em 8% dos pacientes e caracterizaram-se por retração cicatricial, cicatriz visível e alteração ungueal; três casos (6%) foram reoperados para liberação de retração cicatricial com zetaplastia e confecção de neocomissura e quatro casos demandaram realinhamento digital, observado nas sindactilias complexas. Conclusão: Com esta técnica, obtiveram-se 92% de resultados funcionais, 8% de complicações relacionadas à técnica cirúrgica e três reoperações para liberação de retração cicatricial, por meio de zetaplastia e aprofundamento da comissura com novo retalho e enxerto de pele Em relação à avaliação quanto à Escala de Vancouver, o item predominante foi a pigmentação existente entre os dedos devido ao enxerto de pele.
Introduction: Syndactyly is a congenital anomaly of the hand, occurring in approximately 1 in every 2000 births. It is more common in male patients and is present in both hands in 50% of the cases. The objective of this study was to describe a series of cases of patients with hand syndactyly, operated at the Sarah Hospital in Brasília using modified Skoog's technique and orthosis. Methods: The modified Skoog's technique was performed to correct syndactyly. Wrist-hand and finger orthosis was applied postoperatively, and the appearance of the scar was assessed according to the Vancouver Scar Scale. Results: Forty-five patients were assessed during five years, of whom 30 (66%) were male and 15 were female, all aged between 1 and 4 years (mean age: 2 years [60%]); 37% of cases were associated with syndromes and 50% were simple bilateral cases. Complications observed in simple syndactyly occurred in 8% of patients and included scar retraction, visible scars, and ungual changes; three patients (6%) underwent revision surgery with z-plasty and confection of a new web space commissure to correct scar retraction, and four patients required finger realignment, observed in complex syndactyly. Conclusion: This technique resulted in 92% good functional outcomes, 8% complications associated with the surgical technique, and three revision procedures with z-plasty and confection of the web space commissure with a new flap and skin graft to correct scar retraction. The Vancouver scale was used to assess scar quality, and pigmentation between the fingers (due to skin graft) had the highest score.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , History, 21st Century , Hand Deformities, Congenital , Cross-Sectional Studies , Syndactyly , Plastic Surgery Procedures , Evaluation Study , Diagnostic Techniques, Surgical , Hand , Hand Deformities, Congenital/surgery , Hand Deformities, Congenital/pathology , Retrospective Studies , Syndactyly/surgery , Syndactyly/pathology , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Hand/surgery , Hand/pathologyABSTRACT
Objective:To study the technique of treatment of infant hand congenital syndactyly. Methods:All cases were from 6 months to 2 years old .In these cases, the fingers were separated by using the serrated flap and new weh were created deeply and widely by using rectangle or triangle inter-phalangeal flap at dorsal and palmaris. The skin-defected areas were covered with full-thickness skin grafts and the fingers were fixed using small splints. Results: All 38 cases were primary healing except that partial necrosis of skin graft in 10 cases which were healed after dressing change. The scar of 7 Cases were relieved by using small splints at night and glucocorticoid injection treatment. 1 case which finger was bent because of scar was operated again and another one had not any management. Followed up 6 months～2 years,37 cases had good features and functions except one case without dealed. Conclusion:It is feasible that treatment of hand congenital syndactyly durying infancy.
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Objective To analyze the reasons of the common complications happened after the operation of congenital syndactyly and to find the method of prophylaxis and treatment,and to improve the effects of treatment.Methods To classify the reasons of the complications happened after the operation of congenital syndactyly in 34 cases.Results The reasons of the complications included that the patients were not operated by special course of study doctors in 9; operation at an inappropriate opportunity in 8;the method of web taken shape was improper in 7;the method of nail taken shape was improper in 4; the fixation and training was unsuitable in 6. Conclusions The complications happened after the operation of congenital syndactyly will be reduced much , provided that grasping the right opportunity and selecting the proper method of web or finger tip taken shape before operation , taking care of the transformations of blood vessel and nerve in operation , fixing firmly and training appropriately after operation.