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[Late results following surgical correction of syndactyly and symbrachydactyly]
1Abteilung für Plastische und Wiederherstellungschirurgie, Wien.
Insights
Full thickness skin grafts significantly reduce syndactyly recurrence in pediatric hand surgery compared to split thickness grafts. Early surgical intervention with zig-zag incisions is recommended for optimal functional outcomes.
Area of Science:
- Pediatric Hand Surgery
- Congenital Hand Anomalies
- Reconstructive Surgery
Context:
- Syndactyly and symbrachydactyly are common congenital hand differences requiring surgical correction.
- Surgical outcomes in pediatric hand surgery are influenced by technique, including incision type and skin graft choice.
- Assessing functional results, skeletal development, and recurrence rates is crucial for evaluating surgical efficacy.
Purpose:
- To evaluate the efficacy of different surgical techniques, specifically skin graft types and incision methods, for syndactyly and symbrachydactyly in children.
- To compare recurrence rates associated with split-thickness versus full-thickness skin grafts in pediatric hand reconstruction.
- To determine the optimal timing and surgical approach for correcting congenital hand anomalies.
Summary:
- A study of 29 pediatric patients with syndactyly and symbrachydactyly analyzed surgical outcomes based on incision type, skin graft, and functional results.
- Full thickness skin grafts demonstrated a significantly lower recurrence rate (7.5%) compared to split thickness skin grafts (60%).
- Early surgical intervention, particularly for unequal finger lengths, and the use of zig-zag incisions are recommended.
Impact:
- The findings advocate for the routine use of full thickness skin grafts in pediatric syndactyly and symbrachydactyly repair to minimize recurrence.
- Early surgical correction and specific incision techniques can improve functional outcomes and patient satisfaction.
- This research provides evidence-based recommendations for optimizing surgical strategies in pediatric hand reconstruction.
Abstract:
Growth and the type of surgical treatment of the hand play an important role in the results of surgery in children. 29 patients have been operated on because of syndactyly and symbrachydactyly and were controlled. The following parameters were assessed: kind of incision and skin graft, functional results, x-ray to examine the skeleton and the depth of the commissure, colour of the skin graft and use of the hand. After operation of syndactyly all patients were able to use their hands normally, although full extend of flexion and extension was achieved only in 20 of 22 hands. In 5 divided pairs of fingers there was recurrence of syndactyly. In all cases except one, a split thickness skin graft has been used. After operative treatment of symbrachydactyly and complex syndactyly, full extent of flexion was achieved in 13 of 19 hands, in 6 hands the range of flexion was incomplete because of skeleton abnormalities. Recurrence occurred in 9 divided pairs of fingers; in 7 cases, a split thickness skin graft had been used. Despite this, all patients were able to use their hands normally. The use of split thickness skin grafts resulted in a 60% recurrence rate, whereas the use of full thickness skin graft led merely to 7.5% recurrence rate. Our results show the advantage of the full thickness skin graft. As a consequence, full thickness skin graft should be used in all cases. Furthermore, the operation should be performed at an early age, if fingers of unequal length have to be separated. Zig-zag incision should be used in all cases.