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Parent Perspectives for Type B Ulnar Polydactyly Management
Gunnar J Goebel1, Scott N Loewenstein2, Joshua M Adkinson1
1Indiana University School of Medicine, Indianapolis, USA.
Insights
Parents choosing treatment for type B ulnar polydactyly (a common congenital hand difference) prioritize rapid treatment. Suture ligation, though faster, has a higher complication rate and lower satisfaction than excision.
Area of Science:
- Congenital Hand Surgery
- Pediatric Orthopedics
- Plastic Surgery
Background:
- Type B ulnar polydactyly is a frequent congenital hand difference.
- Treatment options include ligation or surgical excision.
- Understanding parental decision-making factors is crucial for optimal care.
Approach:
- Retrospective review of treatment outcomes for type B ulnar polydactyly.
- Telephone surveys administered to parents of treated children (2015-2020).
- Assessment of parental satisfaction, treatment choice rationale, and complications.
Key Points:
- Rapid treatment was a key factor for parents choosing in-office suture ligation.
- Suture ligation had a significantly higher complication rate (64% residual remnant) than excision.
- Residual remnants correlated with significantly lower satisfaction with appearance and outcomes.
Conclusions:
- Parental treatment choices for type B ulnar polydactyly are influenced by various factors, including surgeon recommendations.
- While most parents are satisfied, the urgency for timely treatment often favors ligation.
- Higher complication rates with ligation may impact long-term satisfaction.
Background:
Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with ligation or excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly.
Methods:
We reviewed treatment outcomes and administered a survey by telephone to parents of children with type B ulnar polydactyly treated at a pediatric hospital between 2015 and 2020. We assessed satisfaction, reasons for choosing treatment, and post-management complications.
Results:
The families of 70 of the 156 consecutive treated patients were successfully contacted and agreed to participate (45% response rate). The mean follow-up was 27 months. Twenty-eight chose in-office suture ligation and 42 chose excision. Rapid treatment was prioritized by those who opted for in-office ligation (P = .044). The complication rate for suture ligation was significantly higher than excision (P < .0001), with the most common complication being a residual remnant (nubbin or neuroma stump) (64%). Respondents with residual remnant reported significantly less satisfaction with the appearance of their child's hand (P < .001) and with treatment outcomes (P = .028) compared to those without residual remnants.
Conclusions:
Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Although the majority of parents remain extremely satisfied with their child's outcome regardless of management type, time to treatment plays a determinative role in parents opting for ligation rather than excision in the operating room.
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