Correction Of Syndactyly Research Articles

Comparison Between Surgical Techniques for Correction of Congenital Syndactyly: A Systematic Review and Meta Analysis.

This review aimed to assess which surgical technique has better outcomes to correct one of the most common congenital anomalies of the upper limb: syndactyly. The following databases were used in the search: PubMed, Embase, Cochrane (CENTRAL), LILACS, SciELO, Scopus and Web of Science, on October 27, 2022. Studies that described a surgical technique for correcting syndactyly and evaluated surgical complications were included. Studies about noncongenital or foot syndactyly were excluded. The risk of bias was assessed using a specific method for case reports. For synthesis of results, the characteristics of the studies and techniques were demonstrated by a qualitative analysis. Meta-analysis models were applied for complications, functionality, and aesthetic. 73 studies were included, of which 70 were series or case reports, 27 studies did not use skin grafts and 7 studies used external fixators. To evaluate functional results, 42 studies used only the surgeon's opinion. Meta-analyses showed a higher incidence of scar defects when using skin grafts and of infection when using external fixators. There was no difference for web creep and readmission. Few studies evaluated results using the VSS scale, showing worse scar pigmentation when skin grafts were used, but there was no difference in other parameters (PROSPERO CRD42022368930).

A new concept of webspace reconstruction in syndactyly - An easily reproducible cross-shaped advancement flap

Background and objectiveThe use of sizable dorsal flaps for webspace reconstruction without skin grafting can minimize complications in syndactyly correction. We report the technique and results of a cross-shaped advancement flap for reconstruction of the webspace and coverage of the lateral sides of the bases of the separated fingers in congenital syndactyly. MethodsFrom June 2018 to July 2020, 15 patients with simple or complex syndactyly for webspace reconstruction with a dorsal cross-shaped advancement flap were retrospectively studied. The patients' ages ranged from 5 to 144 months, with a median age of 12 months. Out of these 15 patients, six patients were suffering from bilateral involvement. Withey grading of web creep was used for postoperative evaluation. Scar hyperplasia was assessed using the Vancouver Scar Scale, and Visual Analogue Scale was applied to evaluate the subjective satisfaction of the children's families with the reconstructed finger appearance, pain and function. ResultsThere was no perioperative complication in the group. During an 8–17 months follow-up period, no secondary correction was needed in this group. The average score of Withey scale was 0.1, and Vancouver Scar Scale was 1.5. The Visual Analogue Scale score of appearance, pain and function was 1.8, 0.2 and 1.1, respectively. ConclusionThis technique can reconstruct the webspace and cover the lateral wall of the fingers for syndactyly correction without the risk for web creep or hypertrophic scar.

Correction of Congenital Syndactyly of the Hand with Minimal Full-Thickness Skin Graft from the Weight-Bearing Midline Plantar Area.

Traditional skin grafts for syndactyly often cause color mismatches and unsightly donor sites, whereas no-skin graft methods leave noticeable dorsal hand scars. This study presents a plantar full-thickness skin graft (FTSG) from the weight-bearing midline area for syndactyly repair, a novel approach not previously reported in the literature. The study included 3 groups of patients with congenital syndactyly of the hand who underwent primary operations with plantar FTSG ( n = 70), groin FTSG ( n = 20), and no-skin graft techniques ( n = 22). Postoperative outcomes were evaluated by an assessment panel, and guardians' satisfaction scores were measured. Color similarity between the graft and surrounding skin was assessed using a three-dimensional color space. The plantar FTSG group demonstrated a significantly higher likelihood of receiving an excellent rating compared with the groin FTSG group, with an odds ratio of 6.30 ( P < 0.001). Color difference analysis showed that plantar FTSG more closely matched surrounding skin color than groin FTSG (6.33 versus 22.57; P < 0.001). Guardians reported greater satisfaction with outcomes on the hand in the plantar FTSG group compared with the groin FTSG and no-skin graft (7.16 versus 5.05 and 4.36; P < 0.001) groups. Satisfaction with donor sites was also significantly higher in the plantar FTSG group than in the groin FTSG group (8.23 versus 6.30; P < 0.001). Correction of congenital hand syndactyly using midline plantar FTSG from the weight-bearing area can reduce scarring on the hand dorsum, ensure superior color similarity with surrounding skin, and offer inconspicuous donor sites compared with no-skin graft or groin FTSG techniques. Therapeutic, II.

Features of surgical correction of various forms of hand syndactyly in children. Retrospective study of own treatment experience

Syndactyly is a congenital malformation which is characterized by impaired differentiation of upper extremity tissues. Surgical correction of syndactyly is aimed to achieve satisfactory cosmetic and functional result. Most often, elimination of the total syndactyly form of the fingers implies is achieved by techniques according to Flatt (1962), Cronin (1943), Gilbert (1986), Wood (1998), bone form requires usage of Buck-Gramko technique. Objective. To conduct a retrospective study of surgical treatment results in patients with various forms of hand syndactyly. Methods. The study included 84 patients (109 hands) with hand syndactyly who were operated during the period from 2012 to 2020 in the pediatric orthopedics clinic of the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine. The mean age of patients was 6.5 years (1 to 16), 39 (46.4 %) boys and 45 (53.6 %) girls. Most often syndactyly of III–IV fingers (105 (96.3 %) hands) was managed by the Wood method, namely in 63 (60.0 %) hands and 8 (7.6 %) cases with severe bone forms were corrected by Buck-Gramko method. Rotational skin pieces Ghani and Buck-Gramko were used for surgical correction of I–II fingers syndactyly. Treatment results were evaluated by the Vancouver Scar Scale (VSS). Results. According to VSS, the treatment result was classified as satisfactory in 73 (67.0 %) hands. Complications were noted in 11 (10.1 %) cases: 2 patients (18.2 % of 11) with congenital amniotic membranes were found to have lysis of a free skin piece; 1 (9.1 %) after removal of the bony syndactyly form had deviation of the nail phalanx; 3 (27.3 %) with Poland-syndrome were shown to have scarring of the interdigital space; 5 (45.4 %) with a complex bony form of syndactyly further on developed pulling scars, which caused deformity of the fingers and resulted in a correction in the form of multistage Z-plastics. Conclusions. All the patients showed improvement in the function and cosmetic results of the hand at the end of treatment. The best results were obtained in the case of simple and total forms of syndactyly treated with Wood technique.

Helal Metatarsal Osteotomy in Apert Foot.

Apert syndrome is a rare condition characterized by a craniosynostosis associated with complex bilateral malformations of the hands and feet. Although correction of syndactyly of the extremities is largely described, just a few authors have focused their attention on the gradual subluxation of the second metatarsal head during child growth, with hyper pressure, hyperkeratosis on the plantar surface and acute pain leading to walking impairment. The aim of this study is to describe our experience with the Helal metatarsal osteotomy technique on this group of patients. An oblique osteotomy performed dorsal to plantar, proximal to distal on the subluxed metatarsal bone is carried out. No internal bone fixation is needed, but a fundamental hypercorrective bandage is placed under the plantar surface. Immediate full weight-bearing, 24 hours after surgery, is highly recommended. Seventeen feet of 12 patients were treated between 2003 and 2018. Corrective osteotomy was performed on a single bone in 13 patients, on 2 bones in 3 patients, and on 3 bones on 1 patient. The mean follow-up was 5 years, with a physical examination once a year. No complication such as infection or delayed wound healing was registered. X-rays taken 3 weeks after surgery showed complete bone consolidation and a correction of the previous plantarflexed position of the metatarsal with consistent reduction of pressure and pain for every patient who was able to wear normal shoes again after surgery. The Helal metatarsal osteotomy is a safe, reproducible, and feasible technique that should be considered in cases of painful metatarsal head plantar subluxation in Apert feet. Level IV.

Reconstruction of a Distal Foot Skin Defect Using an Intermediate Dorsal Neurocutaneous Flap.

ObjectiveTo present the use of an intermediate dorsal neurocutaneous flap for the reconstruction of defects on the distal foot.MethodsFrom September 2016 to October 2018, five patients (mean age at operation 33.8 years; range, 7–70 years; female/male = 2/3) with skin defects on one of their feet caused by road‐traffic accidents, electrical injury, and syndactyly correction were retrospectively reviewed. The size of the defects ranged from 2.0 cm × 1.0 cm to 5.0 cm × 3.5 cm. All patients had undergone a reconstruction surgery using intermediate dorsal neurocutaneous flap. One patient underwent a syndactyly correction, and four patients first experienced aggressive debridement. The sizes of the flaps were between 5.0 cm × 2.0 cm and 6.0 cm × 4.0 cm. The function, appearance, and pain of the injured foot were assessed using the Chinese Manchester Foot Pain and Disability Index and visual analogue scale.ResultsThese five patients were systematically followed up for a mean of 15.8 months (range, 12–20 months). The donor sites were closed primarily in two cases, and skin grafts were performed in three cases. All the flaps survived with a success rate of 100%; the wounds healed well, and the color matches were excellent. Partial superficial flap necrosis occurred in one of five flaps, which was treated by dressing change using a hypertonic saline gauze. No significant problems were found at the donor site in any patient immediately afterwards or at follow‐up. There were no problems in any patients associated with wearing shoes. Based on the Chinese Manchester Foot Pain and Disability Index, four patients were strongly satisfied and one was satisfied with the recovery of physical function; all the patients were strongly satisfied with the appearance of the injured foot; all five patients had an excellent score of pain intensity subscale. Except for one patient who reported mild pain, all the other patients reported no pain based on the visual analogue scale. Two typical cases are presented in this paper.ConclusionsThe intermediate dorsal neurocutaneous flap is an alternative and effective technique that can reliably cover minor‐ to medium‐sized defects on the distal foot, toes, and web spaces. This surgical method leads to satisfactory functional recovery with minimal donor site morbidity, and no major vessels need to be sacrificed. This procedure offers an advisable option for orthopaedic surgeons to treat defects on the distal foot.

Dorsal Bilobed Rectangular Flap and Volar Triangular Flap with Back-Cuts in the Correction of Hand Syndactyly

Dorsal Bilobed Rectangular Flap and Volar Triangular Flap with Back-Cuts in the Correction of Hand Syndactyly

Preputial Grafts: The Forgotten Donor Site.

The prepuce is an excellent donor site for skin grafts with minimal donor site morbidity. Full-thickness grafts are often required for correction of congenital syndactyly and in burn contractures. Preputial skin was used for grafting in 18 children: 5 with burn contractures and 13 with congenital syndactyly. Excellent graft take was achieved with appropriate postoperative care. Postoperatively, there were occasional milia (42%) and hyperpigmentation. These grafts were noted to have superior mobility and elasticity. There was no donor site morbidity. Preputial skin is accessible, easy to harvest, and hairless and has minimal donor site morbidity. It is especially well suited for the hands and fingers when elasticity of the graft is beneficial.

Abstract: Syndactyly: National Analysis of Trends in Epidemiology and Surgical Management from 1997–2012

INTRODUCTION: Syndactyly is a common congenital hand deformity with an estimated incidence of 1:2000 live births.1 Previous studies have discussed disparities in the provision of hand and upper limb services in the United States.2 Our study aims are to (1) analyze the epidemiology of syndactyly and trends in surgical management over time; (2) identify socioeconomic disparities affecting treatment. METHODS: A retrospective analysis of the Healthcare Cost and Utilization Project Kids Inpatient Database was performed for all available years (1997, 2000, 2003, 2006, 2009, 2012). Children under the age of three with a diagnosis of syndactyly were retrieved using International Classification of Diseases, Ninth Revision diagnosis codes (ICD-9 755.11, 755.12, 755.55); procedural data for syndactyly correction were also retrieved. Trends over time were analyzed using the Cochran-Armitage test. Patient and hospital characteristics underwent multivariable logistic regression modeling to evaluate predictors of surgical treatment. RESULTS: Overall, 6,401 cases of syndactyly were retrieved over the study period, with an incidence of 16.32/million in 2012. The majority were Caucasian (59.1%) and male (61.5%), admitted to Southern (35.6%), large bed size (59.2%), urban, teaching hospitals (63.3%), with either predominantly Private (49.6%) or Government-based insurance (44.0%). Of these, 12.8% (n=821) underwent procedures for syndactyly correction. Over time there was a significant decrease in surgical correction of syndactyly (20.5% in 1997 to 6.0% in 2012, p<0.001). Of those having surgery, there has been a significant increase in flap-based reconstruction of the hand over time (12.2% in 1997 to 30.6% in 2012, p<0.001). Predictors of not having surgical treatment for syndactyly were Medicaid coverage (OR 1.253, CI 1.066–1.471); lowest three incomes quartiles (OR 1.29, CI 1.051–1.584; OR 1.404, CI 1.152–1.712; OR 1.281, CI 1.062–1.545); admission to a medium (OR 1.248, CI 1.021–1.526), large (OR 1.597, CI 1.321–1.931), urban non-teaching (OR 1.899, CI 1.360–2.653), urban teaching (OR 1.152, CI 1.772–2.615) or Midwestern (OR 1.324, CI 1.054–1.663) hospital. CONCLUSION: The surgical correction of syndactyly within the inpatient setting is decreasing over time. Socioeconomic disparities are evident: Medicaid insurance status and lower household income had significantly lower rates of surgical correction. Minimizing socioeconomic barriers to care may be important steps in enhancing the quality of care that is delivered to vulnerable pediatric populations. Reference Citations: 1. Jordan D, Hindocha S, Dhital M, Saleh M, Khan W. The epidemiology, genetics and future management of syndactyly. Open Orthop J. Bentham Science Publishers; 2012;6:14–27. 2. Squitieri L, Steggerda J, Yang LJ-S, Kim HM, Chung KC. A National Study to Evaluate Trends in the Utilization of Nerve Reconstruction for Treatment of Neonatal Brachial Plexus Palsy [Outcomes Article]. Plast Reconstr Surg [Internet]. 2011;127:277–83.

The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment: A STROBE compliant study.

Numerous techniques have been developed that use various flaps to treat syndactyly. Skin grafts have often been used to cover remaining surgical defects. The long-term aim of surgery is to find new methods of separating the digits without using skin grafts. This paper describes a new surgical technique for the correction of simple, incomplete, and complete syndactyly. The technique consists of a dorsal double-wing flap to cover the newly created web space and zigzag incisions in the fingers, thus avoiding the use of skin grafts in this space. Overall, 35 web spaces in 24 patients were treated using this technique. Patient follow-up ranged from 6 months to nearly 5 years. There were no complications such as hematoma, infection or flap necrosis, and no fingers needed skin grafts after separation. The average operative time for each web space was approximately 45 minutes. Ninety-seven percent of patients treated with the dorsal double-wing flap procedure achieved good function, and superior cosmetic results following a single surgery. The technique is simple, rapid, safe, and easily performed and does not require the use of skin grafts.

Flexion Crease and Web Space Reconstruction for Aesthetic and Functional Correction of Congenital Syndactyly

Purpose: To investigate the efficacy of congenital syndactyly correction with flexion crease and web space reconstruction using a dorsal hourglass-shaped flap without skin graft. Methods: We studied 116 syndactylies in 96 patients. Surgical strategy focused on flexion crease and web space reconstruction using an hourglass-shaped dorsal advancement flap. We assessed for flap necrosis, height and width of the webs according to the criterion of D’Arcangelo, and total active digital motion compared with the normal side. Scar formation was measured by the Vancouver Scar Scale score. We also administered a parent-based satisfactory questionnaire. Results: Mean follow-up was 4.2 years. All syndactylies could be corrected without skin grafts. Dorsal flap plasty facilitated the reconstruction of commissure with a slope of 45° in an hourglass shape. Two cases encountered partial flap loss but healed without surgical intervention. There were no recurrences. According to the criterion of D’Arcangelo, the height and width of 98 webs were good, 16 webs were fair, and 2 webs were poor. Mean total active motion of the index, middle, ring, and little fingers of the affected side was 160, 158, 153, and 150, respectively. Mean Vancouver Scar Scale score was 1.4. After surgery, all parents were satisfied with the appearance and function of the separated fingers. Conclusions: Reconstruction of the flexion crease and web space simultaneously with an hourglass-shaped dorsal advancement flap can achieve good aesthetic and functional outcomes.

Subcutaneous pedicle V–Y flap for release of incomplete congenital syndactyly

Various procedures for correction of congenital syndactyly of hand or foot have been described. For incomplete syndactyly, some of the reported techniques use only local flaps from surrounding tissues. A novel technique for the correction of incomplete syndactyly, using a dorsal triangular flap and two palmar small flaps, is described in this article. A triangular flap is first marked on the affected web space. The size of the flap should be the same as the unaffected side or other web space. Then a straight line is marked from the proximal apex of the triangle to the level of the metacarpophalangeal (MP) joint. After full skin incision, minimal peripheral undermining is done, and the triangular flap is transposed proximally, as in the Y-V advancement procedure, and sutured. Then two incisions are made from the distal part of the flap, transposing small flaps as in the five-flap method, and closed primarily. We treated ten cases of congenital syndactyly of the hand or foot. We were able to correct a good web space without skin grafting in all cases. The design for our technique is simple, and the technique can be performed easily. The operation can be performed in a short time, the blood supply of the flap is preserved, the flap has a wide range of motion, and a deep and smooth dorsal slope is produced. This technique is an attractive alternative to previously reported methods for syndactyly correction.

Long-term results of syndactyly correction by the trilobed flap technique focusing on hand function and quality of life

Syndactyly is usually corrected surgically during the first years of life. The trilobed flap, a surgical method that does not require skin grafting, was developed in the 1990s and the short-term results were comparable with previously reported techniques. Here we report on long-term outcomes, focusing on how children perceive their hand function and quality of life when they grow up. A total of 19 patients (29 web spaces) were operated on between 1990 and 2000, and followed-up 16 years later with questionnaires and clinical tests. The patients reported low QuickDASH scores, normal sensibility and dexterity, and minor cold intolerance. Only two reoperations, due to early web creep, were needed. The condition minimally affected the choice of occupations, leisure activities and perceptions of appearance. The trilobed flap technique for release of syndactyly provides a good long-term outcome with good hand function and minimal impact on the quality of life. IV.

The Use of an Hourglass Dorsal Advancement Flap Without Skin Graft for Congenital Syndactyly

To investigate the efficacy of congenital syndactyly correction with flexion crease and web space reconstruction using a dorsal hourglass-shaped flap without skin graft. We studied 116 syndactylies in 96 patients. Surgical strategy focused on flexion crease and web space reconstruction using an hourglass-shaped dorsal advancement flap. We assessed for flap necrosis, height and width of the webs according to the criterion of D'Arcangelo, and total active digital motion compared with the normal side. Scar formation was measured by the Vancouver Scar Scale score. We also administered a parent-based satisfactory questionnaire. Mean follow-up was 4.2 years. All syndactylies could be corrected without skin grafts. Dorsal flap plasty facilitated the reconstruction of commissure with a slope of 45° in an hourglass shape. Two cases encountered partial flap loss but healed without surgical intervention. There were no recurrences. According to the criterion of D'Arcangelo, the height and width of 98 webs were good, 16 webs were fair, and 2 webs were poor. Mean total active motion of the index, middle, ring, and little fingers of the affected side was 160, 158, 153, and 150, respectively. Mean Vancouver Scar Scale score was 1.4. After surgery, all parents were satisfied with the appearance and function of the separated fingers. Reconstruction of the flexion crease and web space simultaneously with an hourglass-shaped dorsal advancement flap can achieve good aesthetic and functional outcomes. Therapeutic IV.

Results of the correction of syndactyly of the hand by using Skoog's technique

Results of the correction of syndactyly of the hand by using Skoog's technique

Lateral nailfold reconstruction with fingertip tongue-shaped flap and finger web reconstruction with U-shaped flap in syndactyly correction

Objective To investigate the efficacy of lateral nailfold reconstruction with fingertip tongueshaped flap and finger web reconstruction with U-shaped flap in syndactyly correction.Methods From January 2005 to August 2011,28 eases of congenital syndaetyly were treated.Zig-zag incisions were made on both the palmar and dorsal aspects of the fused fingers to separate the fingers.The lateral nailfold was reconstructed with fingertip tongue-shaped flap.Meanwhile,a U-shaped flap was designed between the dorsal metacarpophalangeal joints to form the finger web.The remainder of the lateral sides of the separated fingers was covered with fullthickness skin graft.Light compression dressing and postoperative prophylactie antibiotics were applied.Functional exercises were initiated upon suture removal.Results The finger web in all 28 cases was close to normal.Lateral nailfold reconstruction was satisfactory.There was no exposed distal phalanx.The appearance was good.Significant improvement was seen in finger flexion/extension and adduction/abduction.The overall results were satisfactory.Conclusion Lateral nailfold reconstruction with fingertip tongue-shaped flap and finger web reconstruction with U-shaped tlap is a good option in syndactyly correction.It leads to satisfactory restoration of both appearance and function. Key words: Surgical flaps; Hand deformities,congenital; Syndactyly

Correction of Syndactyly Using a Dorsal Separated V-Y Advancement Flap and a Volar Triangular Flap in Adults

Skin grafts and local flaps are conventional methods of repair for congenital syndactyly, but the results obtained are not always as functional and aesthetic as desired and frequently leave postoperative scars and residual syndactyly. In this article, we describe a new surgical technique for web reconstruction in the correction of simple, incomplete syndactyly. The technique consists of a dorsal separated V-Y advancement flap and a volar triangular flap to cover the newly created web space, thus avoiding skin graft in this space. In all, 15 web spaces in 10 patients were treated using this method. A follow-up period of 6 months to 2 years showed neither recurrence of the deformity nor web creep of any degree. The technique is rapid, safe, easily performed, and reproducible and requires a single surgical procedure. It uses donor tissue identical in color, texture, and thickness, which renders acceptable cosmesis in cases of simple, incomplete syndactyly, therefore, avoiding the use of skin grafts and resulting postoperative scar contracture in the web space.

Dorsal Pentagonal Local Flap: A New Technique of Web Reconstruction for Syndactyly Without Skin Graft

Many techniques for web space reconstruction have been described over the years. However, few techniques are completely satisfactory in terms of cosmetic requirement and functional recovery due to scar contracture, web creep, or conspicuous scarring resulting from skin grafting or additional incisions on the dorsal palm. Based on the anatomy of the dorsal metacarpal artery, the authors describe a local pentagonal advancement flap including perforators of the dorsal metacarpal artery to optimize web reconstruction and facilitate direct closure in the syndactyly treatment. A local dorsal pentagonal advancement flap was used to reconstruct 17 web spaces in ten patients. The skin of the syndactylized fingers was brought to the web space from the dorsum of the two adjacent syndactylized fingers to cover the web area, facilitating a skin graft-free procedure for web reconstruction. All 17 web releases were successfully reconstructed. During the follow-up period of 23-35months, the appearance of all the reconstructed webs was similar to that of the adjacent normal webs, and all the patients had full functional recovery. No case of web creep was reported during this period, and none of the patients required a secondary operation. The dorsal pentagonal advancement flap is a dependable flap based on known perforators from the dorsal metacarpal arteries. The reported technique is a simple and effective technique for the correction of simple syndactyly and is especially suitable for reconstruction of two webs in multiple syndactyly simultaneously, avoiding the need for skin grafts and leaving acceptable scars on the dorsum of the hand for web reconstruction.

Biomechanical Analysis of Surgical Correction of Syndactyly

Biomechanical Analysis of Surgical Correction of Syndactyly

Syndactyly correction: an aesthetic reconstruction

Various flaps have been used with and without skin grafts to separate digits with syndactyly. Dorsal flap techniques with and without grafts result in dorsal and thus more visible scars. Some of the recent techniques which use no grafts are only applicable for some simple syndactylies. The technique described in this paper uses a combination of techniques which have been described previously. A shaped palmar flap is used to create the web space; narrow V-flaps and full-thickness skin grafts are used to resurface the lateral defects on the fingers and reciprocal pulp flaps are used to create aesthetically pleasing nail folds. This technique allows the full thickness grafts to be hidden on the radial and ulnar sides of the fingers and palm. It increases the span of the hand in conditions where there is shortage of palmar skin. A retrospective review has been undertaken of 102 patients in whom 221 webs were reconstructed through 176 surgical procedures. There were 54 cases of simple syndactylies (53%) and the rest were complex. Complications were encountered in 11 operations (6%) and web creep was noted in 12 web spaces (5%). Re-operation for web creep has been carried out in seven web spaces (3%).