Rectangular flaps technique for treatment of congenital hand syndactyly

Comparing Results of Syndactyly Operated Children Younger and Older Than 1 Year

INTRODUCTION

Syndactyly has a cosmetic, functional, and psychosocial impact, and surgical treatment is indicated in most cases. This study aimed to retrospectively identify whether patients undergoing surgical release of syndactyly younger than 1 year presented different results compared with those operated older than 1 year.

METHODS

Patients were assessed through photographic records by 3 independent specialist surgeons for the quality of scar, presence of web creep, rotational, flexion-extension, and lateral flexion deformities using the Withey score.

RESULTS

Thirty-four patients were included in the study, totaling 51 commissures operated. The score was higher in the group operated younger than 1 year (5.83 ± 2.39) compared with the group older than 1 year (3.94 ± 1.93), being statistically significant, with a P value of 0.011.

CONCLUSIONS

Children with syndactyly operated younger than 1 year have worse postoperative outcomes measured by the Withey score than those operated older than 1 year.

Interdigitating Rectangular Flaps and Dorsal Pentagonal Island Flap for Syndactyly Release

PURPOSE

Interdigitating triangular flaps is the most commonly described technique for syndactyly release. However, triangular flaps may be associated with flap misalignment, flap tip necrosis, and a steep learning curve in design and technique. This study describes a series of syndactyly reconstructions using interdigitating rectangular flaps in both simple and complex syndactyly.

METHODS

A single surgeon's experience of syndactyly reconstruction using interdigitating rectangular flaps was reviewed retrospectively. Patient demographics, associated syndromes, operative technique, complications, and recurrences were analyzed.

RESULTS

Ninety-four web spaces in 50 children with 16 simple incomplete, 36 simple complete, 14 complex, 26 complicated, and 2 unclassified syndactylies were reconstructed with interdigitating rectangular flaps. Seventy-eight commissures were reconstructed with a dorsal pentagonal island flap and 16 with a dorsal rhomboid flap. Full-thickness skin grafts were used in 98% of webs. Five major complications required surgical intervention-2 recurrences, 2 web space scarrings, and 1 wound infection. Ten minor complications occurred-skin graft donor site dehiscence (3), partial loss of the skin graft (4), minor distal interphalangeal joint flexion contractures (2), and a case of minor web creep (1). Average follow-up was 13.7 months. All parents were satisfied with the function and appearance of their child's reconstructed digits.

CONCLUSIONS

Interdigitating rectangular flaps provide an effective technique for release of both simple and complex syndactyly. Advantages include easy learning owing to the relative simplicity of design; intraoperative modification of flap design (cut as you go), and wide flap tips, which prevent flap tip necrosis.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Aesthetic Comparison of Two Different Types of Web-Space Reconstruction for Finger Syndactyly

BACKGROUND

Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. The authors' study compares the long-term aesthetic outcomes of these two flap techniques.

METHODS

Forty-five patients were included in the authors' study. The methods of reconstruction used were a dorsally based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting. Eighteen independent raters completed a visual analogue scale and a unique classification scale to subjectively assess aesthetic outcomes. The authors used univariate analyses to determine which variables significantly influenced the outcome score. The authors then used multivariable regression models to compare the two flap types.

RESULTS

Dorsally based rectangular flaps with skin graft had statistically significantly better visual analogue scale scores and greater odds of receiving an "excellent" rating compared with dorsal pentagonal advancement flaps.

CONCLUSIONS

Despite the use of skin grafting, with its associated donor-site morbidity, dorsal rectangular flaps may offer better overall aesthetic outcomes for patients. Future comparative studies should incorporate functional and patient-reported outcomes to better assess the optimal reconstruction type.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

NOSOLOGY OF HAND DISEASES IN CHILDREN AND ADOLESCENTS OPERATED IN PROVISIONAL FACILITIES IN A MODEL HOSPITAL - PERNAMBUCO STATE, BRAZIL

To report the frequencies of congenital hand diseases in patients who underwent surgery on a collective mobilization basis at SOS Hand, Recife, Pernambuco, between 2005 and 2009. Methods: Information was collected from 833 children and adolescents who were examined in eight missions. Results: Among the patients, 306 (36.7%) underwent surgery: 240 (78.4%) because of congenital malformation and 66 (21.6%) because of acquired lesions. The most frequent congenital malformations were: syndactyly, 72 cases (30.0%); polydactyly, 30 cases (12.5%); bifid thumb, 19 cases (7.9%); complex hand malformation, 14 cases (5.8%); cleft hand, 13 cases (5.4%); trigger finger, 12 cases (5.0%); camptodactyly, 11 cases (4.6%); and brachysyndactyly, 9 cases (3.7%). The most frequently acquired injuries were: obstetric traumatic lesions, 26 cases (39.4%); hand trauma sequelae, 18 cases (27.3%); cerebral paralysis sequelae, 7 cases (10.6%); electric shock sequelae, 5 cases (7.6%); and burn sequelae, 4 cases (6.1%). Conclusion: The nosology of hand diseases is similar to that of large series of elective surgery, especially regarding congenital deformities. The frequency of acquired hand lesions seems to be higher than the frequency in international series. The collective mobilization system for hand surgery is important for decreasing the need for this activity in public institutions, and it has been shown to be very efficient. The success of the project may provide support for the Brazilian National Health System to enroll hand surgeons in the on-call system, in emergency units.

Surgical results from treating children with syndactyly through the collective effort system at "SOS Hand Recife" between 2005 and 2009

OBJECTIVE

to evaluate the results from and parents' satisfaction with treatment for children with syndactyly who were operated at the "SOS Hand Recife" hospital between 2005 and 2009.

METHODS

data for assessing the results were gathered from the patients' medical files. The subjective scores, which were ascertained prospectively, were as follows: greater than or equal to 9, good result; between 6 and 8, fair result; less than 6, poor result. The results were analyzed statistically. This study was approved by the institution's ethics committee.

RESULTS

among the 35 cases, 21 (60%) consisted of simple syndactyly and 14 (40%) were complex; 22 (62.8%) were boys and 13 (37.1%) were girls. The complex cases were predominantly among males. The main complications were infection (11.4%), bleeding (11.4%) and pain (8.6%). There were more complications in the complex cases (42.8%) than in the simple cases (33.3%). The mean scores from the parents' subjective evaluations were as follows: 7.6 for esthetics (7.7 in simple cases and 7.3 in complex cases; 8.2 for function (8.6 in simple cases and 7.6 in complex cases); 8.3 for the parents' general satisfaction level (8.6 in simple cases and 8.0 in complex cases); and 85.7% of the parents would recommend the surgery to others while 14.5% would not. A strong association was observed between the specialist's objective assessment and the scores given by the parents (p < 0.05).

CONCLUSION

the surgical results from treating syndactyly presented differences between the simple and complex types, even though the parents' esthetic evaluations and satisfaction were similar.