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Utilization of the web index in the measurement of web creep after syndactyly surgery
Michael Tonkin1, Matthew Donaldson2, David Graham3,4
1University of Sydney Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
Insights
This study found a web index measured on photos effectively tracks web creep after syndactyly surgery in children. The graftless winged flap technique successfully prevented significant web creep in most cases.
Area of Science:
- Pediatric Surgery
- Hand Surgery
- Reconstructive Surgery
Background:
- Syndactyly surgery aims to correct webbed digits, but postoperative web creep can occur.
- Accurate measurement of web position is crucial for assessing surgical outcomes.
- Existing methods for measuring web creep may have limitations.
Purpose of the Study:
- To evaluate the feasibility of using a web index on photographs to measure web creep post-syndactyly surgery.
- To assess the long-term effectiveness of the graftless winged central rectangular web flap in preventing web creep.
Main Methods:
- A web index was developed and validated using direct measurements and photographs.
- Intra- and inter-observer reliability of the web index measurement was assessed.
- Web creep was evaluated using the web index on long-term postoperative photographs of children treated with a specific surgical technique.
Main Results:
- The web index measurement on photographs showed high agreement among observers.
- Excellent reliability was found for the web index measurement method.
- Only one of 13 webs showed minor evidence of web creep after an average of 88 months.
Conclusions:
- Calculating the web index on photographs is an effective method for measuring web position after syndactyly surgery in children.
- The graftless winged central rectangular web flap technique is effective in minimizing or preventing web creep.
Abstract:
The aim of this study was to explore the feasibility of using a web index to measure web creep after syndactyly surgery. A total of 19 hands in nine children (six preoperatively and 13 immediately postoperatively) underwent measurement of their web position. A preliminary study confirmed that the web index measured on the child's hand at the time of surgery was similar to that measured on photographs taken at the same time. Subsequently, an intra- and inter-observer error rate found excellent agreement among four observers measuring the web index using photographs. Of 13 postoperative webs using a winged central rectangular web flap without skin grafting, 12 were re-measured using photographs at an average of 88 months (range 78 to 96) after surgery. There was evidence of minor web creep in one web only. Our study demonstrates the efficacy of web index calculation on photographs to measure web position in children after syndactyly surgery. The study also demonstrates the effectiveness of the graftless winged central rectangular web flap technique in avoiding web creep.Level of evidence: IV.
