Transverse soft tissue distraction preceding separation of complex syndactylies
J A Lohmeyer1, W Hülsemann2, M Mann2
1Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany Department of Plastic Surgery, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany Department of Plastic Surgery and Hand Surgery, Technische Universität München, Munich, Germany.
The Journal of Hand Surgery, European Volume
|October 27, 2015
Summary
This study introduces a two-stage surgical technique for complex syndactyly, improving outcomes in Apert syndrome cases. Progressive soft tissue distraction before release enhances finger separation and aesthetic results.
Area of Science:
- Orthopedic Surgery
- Plastic Surgery
- Pediatric Surgery
Background:
- Standard syndactyly release techniques are often insufficient for complex cases with extensive bony fusion and tight soft tissues.
- Apert syndrome frequently presents with complex syndactylies requiring specialized surgical approaches.
Purpose of the Study:
- To evaluate the efficacy of a two-stage surgical procedure for complex syndactyly, incorporating progressive soft tissue distraction.
- To assess the outcomes and aesthetic improvements in patients with complex syndactylies, particularly those with Apert syndrome.
Main Methods:
- A two-stage surgical approach was employed, beginning with progressive soft tissue distraction using an external fixator at 0.5 mm/day.
- Distraction ranged from 15-25 mm, aiming to increase soft tissue length and improve digital separation.
- The study included 168 complex syndactyly cases treated between 1996 and 2012.
Main Results:
- Progressive soft tissue distraction yielded additional skin, a wider nail matrix, and increased bone formation (callus).
- This facilitated improved modeling of closely fused fingertips, enhancing the surgical outcome.
- The technique proved effective in managing complex syndactyly, leading to better aesthetic results.
Conclusions:
- The described two-stage procedure, including progressive soft tissue distraction, is a valuable technique for managing complex syndactylies.
- This method offers significant advantages over standard techniques, particularly for syndactylies associated with Apert syndrome.
- The approach improves functional and aesthetic outcomes in challenging surgical cases.
