Details

Autor(en) / Beteiligte

• Mallet, Cindy
• Ilharreborde, Brice
• Jehanno, Pascal
• Litzelmann, Estelle
• Valenti, Philippe
• Mazda, Keyvan
• Penneçot, Georges-François
• Fitoussi, Franck

Titel

Comparative Study of 2 Commissural Dorsal Flap Techniques for the Treatment of Congenital Syndactyly

Ist Teil von

• Journal of pediatric orthopaedics, 2013-03, Vol.33 (2), p.197-204

Ort / Verlag

United States: Lippincott Williams & Wilkins, Inc

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• BACKGROUND:Many commissural reconstruction techniques have been described for the treatment of syndactyly. This study is the first to compare long-term results of 2 commissural dorsal flap procedures (T-flap and omega-flap). METHODS:Fifty-nine web-spaces in 39 patients, operated on between 1991 and 2008, were retrospectively analyzed. Thirty-six T-flap and 23 omega-flap procedures were performed using full-thickness skin graft in every case for digital resurfacing. Factors that could affect the long-term outcome were collected, including development of web-creep, clinodactyly, and flexion contracture. Patients were reviewed with a mean follow-up of 5 years and 8 months. RESULTS:Preoperative complexity of syndactyly influenced the development of clinodactyly and flexion contracture. Among the patients who developed clinodactyly, 96% had surgery for complex syndactyly. No difference was found between the 2 flap methods concerning digital deformation and mobility. However, web-creep occurred more frequently after T-flap than after omega-flap procedures (17% vs. 5%). CONCLUSIONS:The combination of either dorsal commissural T-flaps or omega-flaps with full-thickness graft to resurface digits is a reliable technique for the treatment of syndactyly with satisfactory functional and cosmetic results. Long-term results are not influenced by the type of flap. Nevertheless, the omega-flap technique, using 2 triangular lateral-palmar flaps, avoids use of skin graft to cover lateral-palmar aspects of the new commissure, consequently reducing the incidence of web-creep. In cases of syndactyly, the primary prognostic factor is whether the patient has simple or complex syndactyly. In complex syndactyly, the risk of long-term unfavorable results is higher. When complex complicated syndactyly is involved, postoperative complication rates increase. LEVEL OF EVIDENCE:Level III