Intraoperativna tkivna ekspanzija kao alternativni pristup u rešavanju sindaktilija šake kod dece bez primene kožnih transplantata

  • 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
Ključne reči: anomalije;, polidaktilija;, hirurgija, rekonstruktivna, procedure;, odojče;, deca, predškolska;, lečenje, ishod

Sažetak


Uvod/Cilj. U rešavanju sindaktilije šake kod dece u proteklih 200 godina primenjivan je veliki broj hirurških tehnika. Cilj rada je bila procena ishoda lečenja kongenitalne sindaktilije šake primenom tehnike privremene tkivne ekspanzije i lokalnih režnjeva bez upotrebe kožnih transplantata. Metode. Studijom su obuhvaćena deca sa urođenom sindaktilijom šake koja su u periodu 2009–2015. operativno lečena primenom tehnike privremene ekspanzije kože sa dorzalne strane šake i lokalnih režnjeva bez upotrebe kožnih transplantata. Sve operacije su urađene u opštoj anesteziji. Funkcionalni ishod lečenja određivan je prema Weberovoj deskriptivnoj metodi kao dobar, zadovoljavajući i loš. Svi bolesnici su ispitivani radi dijagnostikovanja udruženih anomalija. Rezultati. Ukupno 26 dece (20 dečaka i 6 devojčica), uzrasta od šest meseci  do šest godina (srednji uzrast 23 meseca), operisano je opisanom tehnikom. Dvadeset bolesnika imalo je potpunu, a šest nepotpunu sindaktiliju šake. Najčešće su bili zahvaćeni treći i četvrti prst. Udružne anomalije su otkrivene kod devet bolesnika. Period praćenja trajao je od jedne do pet godina, u proseku  2,6 godina. Funkcionalni ishod lečenja bio je dobar kod 20 bolesnika, zadovoljavajući kod pet i loš kod jednog deteta. Zaključak. Hirurška tehnika privremene ekspanzije kože dorzalne strane šake sa lokalnim režnjevima bez upotrebe kožnih transplantata predstavlja efikasnu metodu za rešavanje urođene sindiktilije šake, sa dobrim funkcionalnim i estetskim rezultatima. Prednost ove tehnike su vremenski kraća operacija i izbegavanje komplikacija kao što su pojava maljavosti, hiperpigmentacije kože i hipertrofičnih ožiljaka. 

Biografije autora

Djordje Kravljanac, Institut for mother and child healthcare of Serbia Belgrade
Department of plastic surgery and burn
Radoje Simic, Institut for mother and child healthcare of Serbia Belgrade Faculty of medicine University of Belgrade
Department of plastic surgery and burn

Reference

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.

Objavljeno
2020/11/17
Broj časopisa
Vol. 75 Br. 3 (2018): Vojnosanitetski pregled
Rubrika
Originalni članak