Surgical treatment in child's congenital toe syndactyly: Risk factor of recurrence, complication and poor clinical outcomes

Surgical Management of Foot Syndactyly: The State of the Art and a Treatment Algorithm Based on a Literature Review

Objectives: This systematic review provides an in-depth analysis of the surgical treatment of foot syndactyly, offering insights into the various options and their applications. The objective is to improve treatment standardization and optimize patient care in cases of foot syndactyly. Methods: By synthesizing the existing evidence, the authors propose a treatment algorithm to guide clinicians in decision-making, considering the type and severity of syndactyly. Results: Sixteen articles were included in the systematic review, comprising a total of 395 patients. The mean age at surgery was 6 years (range: 0.66-23 years). Clinical outcomes were assessed after a mean follow-up of 33.2 months (range: 4-82.8 months). Several surgical procedures were described in the included articles. Conclusions: Continued research efforts and collaborative initiatives are crucial to further refine our understanding of complications and enhance surgical practices in foot syndactyly procedures.

Surgical excision and skin grafting combined with intralesional injection of triamcinolone for the treatment of keloids after syndactyly release

The purpose of this study was to investigate the efficacy of surgery combined with triamcinolone acetonide injection in managing the difficult problem of keloid formation after syndactyly release. Twenty-two patients with keloid formation after syndactyly release were retrospectively reviewed. They were divided into a simple surgery group and a surgery plus injection group. Complications, web quality, scar score and satisfaction were assessed and compared. In the surgery plus injection group, three patients (3/13) experienced recurrence and ten webs were good, whereas in the simple surgery group, seven patients (7/9) experienced recurrence and five webs were poor. The mean Vancouver Scar Scale score was significantly lower (4.3 versus 7.8) and the mean Faces Questionnaire satisfaction score was higher (4.2 versus 2.6) in the surgery plus injection group. Combining surgical excision with early and repeated intralesional injection can achieve better results with low recurrence rate and side effects.Level of evidence: IV.

Recent Advances in Syndactyly: Basis, Current Status and Future Perspectives

A comprehensive summary of recent knowledge in syndactyly (SD) is important for understanding the genetic etiology of SD and disease management. Thus, this review article provides background information on SD, as well as insights into phenotypic and genetic heterogeneity, newly identified gene mutations in various SD types, the role of HOXD13 in limb deformities, and recently introduced modern surgical techniques for SD. This article also proposes a procedure for genetic analysis to obtain a clearer genotype-phenotype correlation for SD in the future. We briefly describe the classification of non-syndromic SD based on variable phenotypes to explain different phenotypic features and mutations in the various genes responsible for the pathogenesis of different types of SD. We describe how different types of mutation in HOXD13 cause various types of SD, and how a mutation in HOXD13 could affect its interaction with other genes, which may be one of the reasons behind the differential phenotypes and incomplete penetrance. Furthermore, we also discuss some recently introduced modern surgical techniques, such as free skin grafting, improved flap techniques, and dermal fat grafting in combination with the Z-method incision, which have been successfully practiced clinically with no post-operative complications.

Pediatric Forefoot Deformities

This article explores different pediatric forefoot deformities including syndactyly, polydactyly, macrodactyly, curly toe, and congenital hallux varus. The epidemiology and genetic background are reviewed for each condition. Preferred treatment options and recommended surgical techniques are discussed with review of the current literature.