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

Authors

  • Iryna Harbuzniak Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
  • Anastasiia Hrуtsenko Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine

DOI:

https://doi.org/10.15674/0030-5987202125-9

Keywords:

Children, congenital anomalies of the hand

Abstract

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.

Author Biographies

Iryna Harbuzniak, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, PhD in Traumatology and Orthopaedics

Anastasiia Hrуtsenko, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD

References

  1. Tonkin, M. A. (2009). Failure of differentiation part I: Syndactyly. Hand Clinics, 25(2), 171-193. https://doi.org/10.1016/j.hcl.2008.12.004
  2. Oberg, K. C., Feenstra, J. M., Manske, P. R., & Tonkin, M. A. (2010). Developmental biology and classification of congenital anomalies of the hand and upper extremity. The Journal of Hand Surgery, 35(12), 2066-2076. https://doi.org/10.1016/j.jhsa.2010.09.031
  3. Al-Qattan, M. M., Al-Thunayan, A., De Cordier, M., Nandagopal, N., & Pitkanen, J. (1998). Classification of the mirror hand-multiple hand spectrum. Journal of Hand Surgery, 23(4), 534-536. https://doi.org/10.1016/s0266-7681(98)80140-x
  4. Buck-Gramcko, D. (2002). Congenital malformations of the hand and forearm. Chirurgie de la Main, 21(2), 70-101. https://doi.org/10.1016/s1297-3203(02)00103-8
  5. Canizares, M. F., Feldman, L., Miller, P. E., Waters, P. M., & Bae, D. S. (2016). Complications and cost of syndactyly reconstruction in the United States: Analysis of the pediatric health information system. HAND, 12(4), 327-334. https://doi.org/10.1177/1558944716668816
  6. Kvernmo, H. D., & Haugstvedt, J. R. (2013). Treatment of congenital syndactyly of the fingers. Tidsskrift for den Norske Laegeforening, 133(15), 1591–1595. https://doi.org/10.4045/tidsskr.13.0147
  7. Little, K. J., & Cornwall, R. (2016). Congenital anomalies of the hand—Principles of management. Orthopedic Clinics of North America, 47(1), 153-168. https://doi.org/10.1016/j.ocl.2015.08.015
  8. Temtamy, S. A., & McKusick, V. A. (1978). The genetics of hand malformations. Birth Defects Original Article Series, 14(3), i–619.
  9. Teoh, L. C., & Lee, J. Y. (2004). Dorsal pentagonal island flap: A technique of web reconstruction for syndactyly that facilitates direct closure. Hand Surgery, 09(02), 245-252. https://doi.org/10.1142/s0218810404002339
  10. Kozin, S. H., & Zlotolow, D. A. (2015). Common pediatric congenital conditions of the hand. Plastic and Reconstructive Surgery, 136(2), 241e-257e. https://doi.org/10.1097/prs.0000000000001499
  11. Green, D. P., Hotchkiss, R. N., Pederson, W. K., & Wolfe, S. V. (2017). Operative surgery of Green's hand, 7th ed. Philadelphia, PA: Elsevier
  12. Gupta, A., Scheker, L. R., & Kay, S. P. J. (2000). The growing hand: diagnosis and management of the upper extremity in children. Mosby Ltd
  13. Hutchinson, D. T., & Frenzen, S. W. (2010). Digital syndactyly release. Techniques in Hand & Upper Extremity Surgery, 14(1), 33-37. https://doi.org/10.1097/bth.0b013e3181cf7d70
  14. Karacaoglan, N., Velidedeoglu, H., Ciçekçi, B., Bozdogan, N., Sahin, U., & Türkgüven, Y. (1993). Reverse W-M plasty in the repair of congenital syndactyly: a new method. British Journal of Plastic Surgery, 46(4), 300–302. https://doi.org/10.1016/0007-1226(93)90007-x
  15. Braun, T., Trost, J., & Pederson, W. (2016). Syndactyly release. Seminars in Plastic Surgery, 30(04), 162-170. https://doi.org/10.1055/s-0036-1593478
  16. Sherif, M. M. (1998). V-Y dorsal metacarpal flap: A new technique for the correction of syndactyly without skin Graft. Plastic and Reconstructive Surgery, 101(7), 1861-1866. https://doi.org/10.1097/00006534-199806000-00013
  17. Greuse, M., & Coessens, B. C. (2001). Congenital syndactyly: Defatting facilitates closure without skin Graft. The Journal of Hand Surgery, 26(4), 589-594. https://doi.org/10.1053/jhsu.2001.26196
  18. Aydn, A., & Ozden, B. C. (2004). Dorsal metacarpal island flap in syndactyly treatment. Annals of Plastic Surgery, 52(1), 43-48. https://doi.org/10.1097/01.sap.0000096440.14697.e5
  19. Yoon, A. P., & Jones, N. F. (2019). Interdigitating rectangular flaps and dorsal pentagonal island flap for syndactyly release. The Journal of Hand Surgery, 44(4), 288-295. https://doi.org/10.1016/j.jhsa.2019.01.017
  20. Ferrari, B. R., & Werker, P. M. (2018). A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: Does skin grafting influence satisfaction? Journal of Hand Surgery (European Volume), 44(3), 296-303. https://doi.org/10.1177/1753193418808183
  21. Buck-Gramcko, D. (1998). Syndactyly between the thumb and index finger. In Congenital Malformations of the Hand and Forearm. New York : Churchill Livingston
  22. Friedman, R., & Wood, V. E. (1997). The dorsal transposition flap for congenital contractures of the first web space: A 20-year experience. The Journal of Hand Surgery, 22(4), 664-670. https://doi.org/10.1016/s0363-5023(97)80126-8
  23. Poke, K., & Haugstvedt, S. (2004). Inspection of syndactyly. Materials of the Norwegian Surgical Association. http://www.grafiskpartner.no/hostmotet/2004/frie_foredrag_190-201.htm
  24. Flatt, A. E. (1994). Webbed fingers. In The care of congenital hand anomalies (p. 228–275). St. Louis, MO : Quality Medical Publishing.
  25. Waters, P. M. (2012). Syndactyli. In Pediatric hand and upper limb surgery. A practical guide (pp. 12-25). Lippincott Williams & Wilkins.
  26. Dao, K. D., Shin, A. Y., Billings, A., Oberg, K. C., & Wood, V. E. (2004). Surgical treatment of congenital syndactyly of the hand. Journal of the American Academy of Orthopaedic Surgeons, 12(1), 39-48. https://doi.org/10.5435/00124635-200401000-00006
  27. Ghani, H. A. (2006). Modified dorsal rotation advancement flap for release of the thumb web space. Journal of Hand Surgery, 31(2), 226-229. https://doi.org/10.1016/j.jhsb.2005.10.004
  28. Nachemson, A., & Hessman, P. (2009). Reconstruction of the Apert arms with the Cube fix distractor: Proceedings of the 8th World Symposium on Congenital Upper Limb Hand Defects. Hamburg
  29. Durani, P., McGrouther, D. A., & Ferguson, M. W. J. (2009). Current scales for assessing human scarring: a review. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62(6), 713–20. https://doi.org/10.1016/j.bjps.2009.01.080

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How to Cite

Harbuzniak, I., & Hrуtsenko A. (2023). Features of surgical correction of various forms of hand syndactyly in children. Retrospective study of own treatment experience. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (2), 5–9. https://doi.org/10.15674/0030-5987202125-9

Issue

No. 2 (2021)

Section

ORIGINAL ARTICLES

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