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Syndactyly correction of the hand in Apert syndrome
R M Zucker1, H J Cleland, T Haswell
1University of Toronto, Ontario, Canada.
Insights
Surgical correction for Apert hand syndactyly, involving digit separation and reconstruction, aims for functional and aesthetic improvement. Early intervention between 6 months and 3 years yields optimal outcomes for independent finger motion and hand appearance.
Area of Science:
- Plastic Surgery
- Pediatric Orthopedics
- Congenital Hand Anomalies
Background:
- Syndactyly, a congenital condition involving fused digits, is a common feature of Apert syndrome.
- Early surgical intervention is crucial for optimal functional and aesthetic outcomes in affected children.
Purpose of the Study:
- To outline a comprehensive surgical strategy for syndactyly correction in Apert hands.
- To emphasize the importance of timing and staged procedures for maximizing hand function.
Main Methods:
- Surgical correction initiated between 6 months and 3 years of age.
- Prioritizing digit separation based on functional importance, starting with the first web space.
- Utilizing Z-plasty, dorsal skin flaps, and pedicled groin flaps for complex syndactyly reconstruction.
Main Results:
- Achieved reconstruction of a five-digit hand with adequate grasp.
- Resulted in stable, sensate, and well-aligned digits.
- Enabled children to attain independent finger motion and aesthetically improved hands.
Conclusions:
- A staged surgical approach, beginning early, can effectively correct syndactyly in Apert hands.
- The described techniques facilitate functional restoration and aesthetic enhancement, improving quality of life.
Abstract:
Surgical correction of syndactyly of the Apert hand should begin by 6 months and be completed by 3 years of age. As much surgery as possible is carried out at each sitting. Digit separation should be in order of functional importance. The first web space is deepened with a four-flap Z-plasty or a dorsal skin flap from the web and index finger. Syndactyly release using a dorsal flap and zig-zag technique is used to create the second and fourth web spaces. The complex long-ring syndactyly often requires a pedicled groin flap for reconstruction and preservation of growth potential. A five-digit hand can be achieved with adequate grasp and stable, sensate, well-aligned digits. These children can attain some degree of independent finger motion and aesthetically acceptable hands with this approach.