| Comparative study of 2 commissural dorsal flap techniques for the treatment of congenital syndactyly. | |
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MedLine Citation:
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PMID: 23389576 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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Cindy Mallet; Brice Ilharreborde; Pascal Jehanno; Estelle Litzelmann; Philippe Valenti; Keyvan Mazda; Georges-François Penneçot; Franck Fitoussi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of pediatric orthopedics Volume: 33 ISSN: 1539-2570 ISO Abbreviation: J Pediatr Orthop Publication Date: 2013 Mar |
Date Detail:
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Created Date: 2013-02-07 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8109053 Medline TA: J Pediatr Orthop Country: United States |
Other Details:
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Languages: eng Pagination: 197-204 Citation Subset: IM |
Affiliation:
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Department of Pediatric Orthopedics, Robert Debré Hospital, Paris, France. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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