Intraoperative tissue expansion as an alternative approach for hand syndactyly management to avoid skin grafts in children

Djordje Kravljanac; Radoje Simic; Ivan Milovic

Djordje Kravljanac Institut for mother and child healthcare of Serbia Belgrade
Radoje Simic Institut for mother and child healthcare of Serbia Belgrade Faculty of medicine University of Belgrade
Ivan Milovic Institut for mother and child healthcare of Serbia Faculty of medicine, University of Belgrade

Keywords: congenital abnormalities;, polydactyly;, reconstructive surgical procedures;, infant;, child, preschool;, treatment outcome

Abstract

Background/Aim. A great number of syndactyly release techniques have been described over last two centuries. The aim of our study is outcome assessment of congenital syndactyly surgery using temporary tissue expansion of the dorsal hand and local flaps, without skin grafts. Methods. This study included children with congenital hand syndactyly treated in period from 2009–2015 by operative technique with temporary tissue expansion of the dorsal hand skin and local flaps, without skin grafting. In all cases surgery was performed under general anesthesia. According to Weber’s descriptive method, the functional outcome at the end of the follow-up period was categorized as good, fair or bad. All patients were evaluated for associated anomalies.
Results. A total of 26 children (20 males, 6 females), aged from 6 months to 6 years (average age of 23 months), were operated by previously described technique. There were 20 patients with complete syndactyly and 6 with incomplete, mostly involving the third web. Associated anomalies were diagnosed in 9 patients. The follow-up period ranged from 1 to 5 years with average duration of 2.6 years. The functional results were good in 20 patients, fair in 5 and bad in 1 patient. Conclusion. Surgical procedure with temporary tissue expansion of the dorsal hand skin and local flaps, without skin grafting is effective method of congenital syndactyly treatment in children with good functional and aesthetic results. The advantages of this technique are the reduction of surgery duration and avoiding certain complications, such as web hair growth, hyperpigmentation and hypertrophic scars.

Author Biographies

Djordje Kravljanac, Institut for mother and child healthcare of Serbia Belgrade

Department of plastic surgery and burns

Radoje Simic, Institut for mother and child healthcare of Serbia Belgrade Faculty of medicine University of Belgrade

Department of plastic surgery and burn

References

Kay SP. Syndactyly. In: Green DP, Hotchkiss RM, Pederson WC, Wolf SW, editors. Green's operative hand surgery. 5th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 1381−91.

Hutchinson DT, Frenzen SW. Digital syndactyly release. Tech Hand Up Extrem Surg 2010; 14(1): 33–7.

Kozin SH. Syndactyly. J Am Soc Surg Hand 2001; 1: 1−13.

Weber DM, Schiestl CM. Absorbable Sutures Help Minimise Patient Discomfort and Reduce Cost in Syndactyly Release. Eur J Pediatr Surg 2004; 14(3): 151−4.

D'Arcangelo M, Gilbert A, Pirrello R. Correction of syndactyly using a dorsal omega flap and two lateral and volar flaps. A long-term review. J Hand Surg Br 1996; 21(3): 320‒4.

Buck-Gramcko D. Progress in the treatment of congenital mal-formations of the hand. World J Surg 1990; 14(6): 715‒24.

Niranjan NS, Azad SM, Fleming AN, Liew SH. Long term re-sults of primary syndactyly correction by the trilobed flap technique. Br J Plast Surg 2005; 58(1): 14−21.

Takashi O, Pushman AG, Chung KC. Treatment of common congenital hand conditions. Plast Reconstr Surg 2010; 126(3): 121e−33e.

Kravljanac D, Simic R. Tissue expansion technique for treatment of congenital hand syndactyly. Archdischild 2014; 99(Suppl 2): A550−1.

Yildirim C, Sentürk S, Keklikçi K, Akmaz I. Correction of syn-dactyly using a dorsal separated V-Y advancement flap and a volar triangular flap in adults. Ann Plast Surg 2011; 67(4): 357−63.

Deunk J, Nicolai JP, Hamburg SM. Long term results of syndac-tyly correction: Full-thickness versus split-thickness skin grafts. J Hand Surg Br 2003; 28(2): 125−30.

Moss AL, Foucher G. Syndactyly: can web creep be avoided?. J Hand Surg Br 1990; 15(2): 193−200.

Percival NJ, Sykes PJ. Syndactyly: A review of the factors which influence surgical treatment. J Hand Surg Br 1989; 14(2): 196−200.

Ekerot L. Correction of syndactyly: Advantages with a non-grafting technique and the use of absorbable skin sutures. Scand J Plast Reconstr Surg Hand Surg 1999; 33(4): 427−31.

Niranjan NS, De Carpentier J. A new technique for the division of syndactyly. Eur J Plast Surg 1990; 13: 101−4.

Hsu VM, Smartt JM Jr, Chang B. The modified v-y dorsal metacarpal flap for repair of syndactyly without skin graft. Plast Reconstr Surg 2010; 125(1): 225−32.

Gruese M, Coessens BC. Congenital syndactyly: deffating facili-tates closure without skin graft. J Hand Surg A 2001; 26(4): 589−94.

Cetik O, Ozsar BK, Eksioglu F, Uslu M, Cetik G. Contrary intermittent skin release of complete syndactyly without skin graft in adults. Ann Plast Surg 2005; 55(4): 359−62.

Neumann C. The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear. Plast Re-constr Surg (1946) 1957; 19(2): 124−30.

Radovan C. Tissue expansion in soft-tissue reconstruction. Plast Reconstr Surg 1984; 74(4): 482−90.

Coombs CJ, Mutimer KL. Tissue expansion for the treatment of complete syndactyly of the first web. J Hand Surg Am 1994; 19(6): 968−72.

Ashmead D, Smith PJ. Tissue expansion for Apert's syndactyly. J Hand Surg Br 1995; 20(3): 327−30.