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Surgical Correction for Pediatric Epiblepharon and Trichiasis
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Complex syndactyly: aesthetic and objective outcomes.

Charles A Goldfarb1, Jennifer A Steffen, Christopher M Stutz

  • 1Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA. goldfarbc@wudosis.wustl.edu

The Journal of Hand Surgery
|September 4, 2012
PubMed
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Surgical reconstruction of complex syndactyly often results in finger deformities. This study analyzes outcomes, revealing common rotational and angular issues, and informs modified surgical approaches for better results.

Area of Science:

  • Plastic Surgery
  • Orthopedic Surgery
  • Hand Surgery

Background:

  • Complex syndactyly, particularly with osseous bridges, presents unique surgical challenges.
  • Limited outcome data exists for the surgical treatment of complex syndactyly.

Purpose of the Study:

  • To critically analyze and report the results of surgical reconstruction for complex syndactyly.
  • To identify common postsurgical deformities and inform modified surgical techniques.

Main Methods:

  • Retrospective analysis of 13 patients (21 hands) with complex syndactyly (osseous bridge between distal phalanges).
  • Exclusion of complicated and syndrome-associated cases.
  • Clinical examination and subjective assessment at an average of 9 years post-surgery.

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Main Results:

  • Average Vancouver Scar Scale score of 3; average web creep of 1.5.
  • Common postsurgical findings included rotational (e.g., supination, pronation) and angular (e.g., ulnar/radial deviation) deformities.
  • Nail wall deformities were frequent; patient-reported outcomes for pain, appearance, and function were generally favorable.

Conclusions:

  • Complex syndactyly reconstruction is challenging, frequently leading to rotational, angular, and nail deformities.
  • Deformities often manifest as fingers rotating away from and deviating towards the previous syndactyly site.
  • Findings have led to modifications in surgical approach to improve outcomes.