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Tan RES, Kyi YW, Chong AKS, Sebastin SJ. Pedicled Osteo-Onchyocutaneous Island Flap for Finger Macrodactyly: A Review of Literature. J Hand Surg Am 2022; 47:588.e1-588.e8. [PMID: 34078548 DOI: 10.1016/j.jhsa.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/17/2021] [Indexed: 02/02/2023]
Abstract
We present a case of middle finger macrodactyly reconstructed in a single stage using multiple techniques. We elevated a pedicled osteo-onychocutaneous island flap, excised the remnant distal phalanx with a segment of 1 digital nerve and skin over the dorsum of the middle phalanx, performed epiphysiodesis and reduction of the middle phalanx as well as soft-tissue debulking, and inset the flap over the dorsum of the middle phalanx. Follow-up at 12 months revealed a satisfactory aesthetic and functional outcome.
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Affiliation(s)
- Ruth En Si Tan
- Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore
| | - Ye Win Kyi
- Defence Services Orthopaedic Hospital, Yangon, Myanmar
| | - Alphonsus Khin-Sze Chong
- Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sandeep Jacob Sebastin
- Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore
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2
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Mansur H, Maranho DA. Shortening Scarf Osteotomy for Macrodactyly and Valgus of the Hallux in Acrodysostosis Lesser Toes Brachydactyly. Foot Ankle Spec 2021; 14:158-163. [PMID: 33215519 DOI: 10.1177/1938640020970364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Level V: Case report.
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Affiliation(s)
- Henrique Mansur
- Department of Orthopaedics Surgery, University of Brasília, Brasilia, Brazil (HM) and Hospital Sírio-Libanês, Brasilia, Distrito Federal, Brazil
| | - Daniel Augusto Maranho
- Department of Orthopaedics Surgery, University of Brasília, Brasilia, Brazil (HM) and Hospital Sírio-Libanês, Brasilia, Distrito Federal, Brazil
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3
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Sabapathy SR, Mohan M, Zhang D. Complex macrosyndactyly: the long-term functional results of staged reconstruction in two cases. J Hand Surg Eur Vol 2020; 45:414-415. [PMID: 31805801 DOI: 10.1177/1753193419890542] [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: 02/03/2023]
Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, India
| | - Monusha Mohan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, India
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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4
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Overgrowth. Plast Reconstr Surg 2017. [DOI: 10.1007/978-981-10-5101-2_9] [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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5
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Abstract
Background: Nail surgery can be performed in an office-based dermatology practice with a limited amount of specialized equipment and training. Several excellent reviews have been published in recent years that detail the techniques of nail surgery for both the novice and the experienced practitioner. Objective: In this article recent developments in nail surgery are discussed. Topics that are treated include the general principles of nail surgery, including epidemiologic issues, studies of nail anatomy, instrumentation, and anesthesia. The reconstruction of injuries and congenital defects involving the nail is explained, and the role of the hand surgeon clarified. Appropriate removal of tumours and cysts is considered, with special attention to the management of malignant lesions. The controversy regarding more or less conservative management of melanonychia striata is addressed, and the need for early diagnosis of subungual melanoma is emphasized. Other topics are surgical management of ingrown nails and onychomycosis. Newer areas of nail surgery, such as laser surgery of the nail, psycho-dermatology of the nail, and the role of primary care physicians in simple nail surgery are also examined.
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Affiliation(s)
- Murad Alam
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Richard K. Scher
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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6
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Zhang X, Liu Y, Xiao B, Li Y. Two cases of macrodactyly of the foot: relevance in pediatric orthopedics. J Pediatr Orthop B 2016; 25:142-7. [PMID: 26569430 DOI: 10.1097/bpb.0000000000000242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital enlargement of one or several digits of the foot, known as macrodactyly, is a rare malformation. Macrodactyly impedes foot development and affects function and gait. Here, we describe a surgical technique used to correct macrodactyly in two pediatric patients. We performed amputation of the enlarged phalanx and debulking of the soft tissues to construct a normal-sized digit. This precise technique involves a simple surgical plan that preserves the metatarsus and cuneiform and does not result in a wide plantapedis. Both patients subsequently showed improved gait and were able to wear normal shoes.
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Affiliation(s)
- Xianying Zhang
- Center of Burns and Plastic Surgery, Chinese People's Liberation Army Lanzhou General Hospital of Lanzhou Command, Lanzhou, Gansu Province, China
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7
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Kim J, Park JW, Hong SW, Jeong JY, Gong HS, Baek GH. Ray amputation for the treatment of foot macrodactyly in children. Bone Joint J 2015; 97-B:1364-9. [DOI: 10.1302/0301-620x.97b10.35660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Macrodactyly of the foot is a rare but disabling condition. We present the results of surgery on 18 feet of 16 patients, who underwent ray amputation and were followed-up for more than two years at a mean of 80 months (25 to 198). We radiologically measured the intermetatarsal width and forefoot area pre-operatively and at six weeks and two years after surgery. We also evaluated the clinical results using the Oxford Ankle Foot Questionnaire for children (OxAFQ-C) and the Questionnaire for Foot Macrodactyly. The intermetatarsal width and forefoot area ratios were significantly decreased after surgery. The mean OxAFQ-C score was 42 (16 to 57) pre-operatively, improving to 47 (5 to 60) at two years post-operatively (p = 0.021). The mean questionnaire for Foot Macrodactyly score two years after surgery was 8 (6 to 10). Ray amputation gave a measurable reduction in foot size with excellent functional results. For patients with metatarsal involvement, a motionless toe, or involvement of multiple digits, ray amputation is a clinically effective option which is acceptable to patients. Cite this article: Bone Joint J 2015;97-B:1364–9.
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Affiliation(s)
- J. Kim
- Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul
110-744, Republic of, Korea
| | - J. W. Park
- Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul
110-744, Republic of, Korea
| | - S. W. Hong
- Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul
110-744, Republic of, Korea
| | - J. Y. Jeong
- Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul
110-744, Republic of, Korea
| | - H. S. Gong
- Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul
110-744, Republic of, Korea
| | - G. H. Baek
- Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul
110-744, Republic of, Korea
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8
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Hop MJ, van der Biezen JJ. Ray reduction of the foot in the treatment of macrodactyly and review of the literature. J Foot Ankle Surg 2011; 50:434-8. [PMID: 21601486 DOI: 10.1053/j.jfas.2011.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 03/31/2011] [Indexed: 02/03/2023]
Abstract
Macrodactyly of the foot is a rare disorder characterized by enlargement of the soft tissue and osseous elements of the foot that impedes the development of normal function and gait. Despite the morbidity associated with this condition, many surgeons are reluctant to perform surgical reduction. In the present report, we describe 3 pediatric patients with pedal macrodactyly, who underwent surgical correction consisting of amputation of the most enlarged ray, reduction of the adjacent rays, and ray transposition, combined with debulking of soft tissues. All 3 patients subsequently developed a normal gait and were able to wear normal, or minimally adjusted, shoes. We advocate early surgical treatment of macrodactyly of the foot to enhance the development of normal function and gait.
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Affiliation(s)
- M Jenda Hop
- Department of Plastic and Reconstructive Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
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9
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Fengdong Z, Rongrong Z, Peihua S, Shunwu F. Macrodactyly of the great toe for thirty-five years. J Plast Reconstr Aesthet Surg 2009; 62:e520-2. [DOI: 10.1016/j.bjps.2008.04.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 04/11/2008] [Accepted: 04/15/2008] [Indexed: 10/21/2022]
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10
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Casanova D, Chabas JF, Salazard B. Les macrodactylies de la main et du pied. ACTA ACUST UNITED AC 2008; 27 Suppl 1:S178-84. [DOI: 10.1016/j.main.2008.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Uemura T, Kazuki K, Okada M, Egi T, Takaoka K. A case of toe macrodactyly treated by application of a vascularised nail graft. ACTA ACUST UNITED AC 2005; 58:1020-4. [PMID: 16039630 DOI: 10.1016/j.bjps.2005.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 05/17/2005] [Indexed: 11/18/2022]
Abstract
Macrodactyly is a relatively rare congenital abnormality of the fingers and toes and is difficult to treat. We report a new method for treating toe macrodactyly in which a nail with a vascularised pedicle is raised, the toe is shortened to an appropriate length, and the nail transferred to an aesthetically appropriate proximal site. Although this technique is of a higher level of difficulty than conventional procedures involving pedicled nail flaps, allows aesthetically more favourable nail reconstruction by single-stage operation.
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Affiliation(s)
- T Uemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan.
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12
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Dautel G, Vialaneix J, Faivre S. Island nail transfer in the treatment of macrodactyly of the great toe: a case report. J Foot Ankle Surg 2004; 43:113-8. [PMID: 15057859 DOI: 10.1053/j.jfas.2004.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Macrodactyly involving the great toe is difficult to treat when both the functional and cosmetic problems are addressed simultaneously. Partial resection of the distal phalanx is an easy way to reduce the length of the involved toe. However, there are cosmetic concerns with loss of the toenail. The authors report on a clinical case in which shortening and debulking of the toe was performed while preserving the hallux nail. The nail complex was transferred as an island flap to the dorsal aspect of the proximal phalanx. At the 1-year follow-up, the length of the reconstructed toe was significantly decreased, with a normal-looking nail.
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Affiliation(s)
- Gilles Dautel
- Service de Chirurgie Reconstructrice de l'Appareil Moteur, Hôpital Jeanne d'Arc, Cedex, France.
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Raja Sabapathy S, Venkatramani H, Bharathi R, Jayachandran S. Reconstruction of finger tip amputations with advancement flap and free nail bed graft. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2002; 27:134-8. [PMID: 12027486 DOI: 10.1054/jhsb.2001.0695] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fifteen finger tip amputations through the proximal half of the nail bed were reconstructed with palmar V-Y advancement flaps and full thickness nail bed grafts. The undersurface of the V-Y flap was sutured to the nail bed remnant and the raw area was covered with full thickness nail bed grafts from the amputated part. They were followed for a minimum period of one year and the nail bed grafts took fully in all patients. The results were best in the thumb and least favourable in the little finger but all the patients were happy with the cosmetic result and the functional outcome. This technique results in an average gain of 5 mm of extra length to the nail. This is a useful technique when replantation of a distal fingertip amputation is not possible.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganja Hospital, Ramnagar, Coimbatore, India.
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14
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Grogan DP, Bernstein RM, Habal MB, Ogden JA. Congenital lipofibromatosis associated with macrodactyly of the foot. FOOT & ANKLE 1991; 12:40-6. [PMID: 1959834 DOI: 10.1177/107110079101200108] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Congenital lipofibromatosis of the foot, a type of paracrine growth disorder, is a distinct clinical entity that must be differentiated from other causes of macrodactyly, with specific diagnostic and therapeutic considerations. Eleven skeletally immature patients with congenital lipofibromatosis and macrodactyly of the foot were studied. Diagnostic histopathologic criteria were documented. The most specific pathologic finding of congenital lipofibromatosis is an overabundance of fibrofatty tissue on the plantar aspect of the foot and involved toes. Surgical defatting or debulking procedures, ray resection, and phalangeal epiphysiodesis produced significant cosmetic improvement. Syndactylization and phalangeal resection were not as beneficial.
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Affiliation(s)
- D P Grogan
- Shriners' Hospital for Crippled Children, Tampa, Florida 33612
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