CT angiography-guided single-stage release of adjacent webspaces in non-Apert syndactyly

Hynes, Sally; Harvey, Isaac; Thomas, Karen E.; Copeland, Jocelyne; Borschel, Gregory H.

doi:10.1177/1753193414541222

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…Congenital syndactyly is the second most common congenital hand anomaly, which results from the failure of developmental separation of adjacent digital rays, and has an incidence of 1:2000 live births. [ 1 ] Congenital syndactyly has a strong familial tendency, and is usually bilateral. [ 2 , 3 ] The condition may present as an isolated abnormality, or in association with complex conditions such as Poland syndrome, Apert syndrome, or cleft hand.…”

Section: Introductionmentioning

confidence: 99%

The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment

Dong

Wang

2017

Medicine

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Numerous techniques have been developed that use various flaps to treat syndactyly. Skin grafts have often been used to cover remaining surgical defects. The long-term aim of surgery is to find new methods of separating the digits without using skin grafts. This paper describes a new surgical technique for the correction of simple, incomplete, and complete syndactyly. The technique consists of a dorsal double-wing flap to cover the newly created web space and zigzag incisions in the fingers, thus avoiding the use of skin grafts in this space. Overall, 35 web spaces in 24 patients were treated using this technique. Patient follow-up ranged from 6 months to nearly 5 years. There were no complications such as hematoma, infection or flap necrosis, and no fingers needed skin grafts after separation. The average operative time for each web space was approximately 45 minutes. Ninety-seven percent of patients treated with the dorsal double-wing flap procedure achieved good function, and superior cosmetic results following a single surgery. The technique is simple, rapid, safe, and easily performed and does not require the use of skin grafts.

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Section: Introductionmentioning

confidence: 99%

The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment

Dong

Wang

2017

Medicine

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“…The surgical protocol for CSM usually includes three key parts: separation of syndactyly, plasty of syndactylous webs, and surface coverage of the wound ( 4 , 15 , 26 , 27 ). Different surgical modes are chosen according to the bifurcation site of the hand vessels when the fingerwebs are separated and take shape ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…Before surgery, it is crucial for surgeons to determine the bifurcation of the common palmar digital arteries (CPDAs) and the maturity of the proper palmar digital arteries (PPDAs) of the affected hand, which guarantees a better prognosis and prevention of serious vascular compromise ( 12 – 14 ). Currently, the imaging methods for preoperative assessment of palmar digital vessels include ultrasound, computed tomography angiography (CTA) and magnetic resonance imaging (MRI) ( 1 , 10 , 15 , 16 ). However, CTA involves ionizing radiation, and visualization of the soft tissue of hands is not satisfactory.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative MRI Evaluation of Hand Vessels in Children With Congenital Syndactyly Malformation by a Contrast-Enhanced Three-Dimensional Water-Selective Cartilage Scan

et al. 2022

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BackgroundIt is crucial to preoperatively assess the arteries of the hands in congenital syndactyly malformation (CSM) patients because this information can affect the therapeutic outcome and prognosis.ObjectiveTo investigate the value of a contrast-enhanced three-dimensional water-selective cartilage scan for the preoperative evaluation of CSM in children.Materials and MethodsContrast-enhanced three-dimensional water-selective cartilage scan 3.0 T magnetic resonance imaging (MRI) performed in 16 clinically diagnosed CSM patients with 17 affected hands. The arteries of the hands were displayed with a focus on the bifurcation position of the common palmar digital arteries (CPDAs) and the maturity of the proper palmar digital arteries (PPDAs). The MRI results were interpreted by consensus between two experienced pediatric radiologists with 10 years of MRI experience each. The MRI findings were compared with the operation results.ResultsOf 51 CPDAs in the 17 affected hands, MRI showed that 30 had an abnormal bifurcation position and 20 had a normal position, and of the 102 PPDAs, 14 were shown to have an abnormal maturity and 85 a normal state, which were confirmed by surgery. The accuracy, sensitivity and specificity for determining the bifurcation position of the CPDAs based on MR maximum intensity projection reconstructed images were 98.04% (50/51), 96.77% (30/31) and 100% (20/20), respectively. The maturity of the PPDAs was judged by MR maximum intensity projection reconstructed images with an accuracy, sensitivity and specificity of 97.06% (99/102), 82.35% (14/17) and 100% (85/85), respectively.ConclusionContrast-enhanced three-dimensional water-selective cartilage scan has excellent performance in displaying the bifurcation position of the CPDAs and the maturity of the PPDAs and is of high value for the preoperative evaluation of CSM in children.

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“…Preoperative evaluation of the soft and bony tissue elements in the syndactylized hand is necessary in every patient and done using conventional radiology images and computed tomography (CT) scan images. 3 Hynes et al 3 found that CT angiographically guided release of adjacent webspaces benefits the patient. However, CT imaging has numerous disadvantages, like radiation, costs, and need for anesthesia when used for children.…”

Section: Introductionmentioning

confidence: 99%

Virtual Incision Pattern Planning using Three-Dimensional Images for Optimization of Syndactyly Surgery

Hoevenaren

Vreeken

Verhulst

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Summary:Syndactyly is a congenital condition characterized by fusion of the fingers. If not treated correctly during infancy, syndactyly may hinder the normal development of hand function. Many surgical techniques have been developed, with the main goal to create a functional hand with the smallest number of operative corrections. Therefore, exact preoperative planning of the reconstructive procedure is essential. An imaging method commonly used for preoperative planning is 3-dimensional (3D) surface imaging. The goal of this study was to implement the use of this technique in hand surgery, by designing a virtual planning tool for a desyndactylization procedure based on 3D hand images. A 3D image of a silicon syndactyly model was made on which the incision pattern was virtually designed. A surgical template of this pattern was printed, placed onto the silicon model and delineated. The accuracy of the transfer from the virtual delineation toward the real delineation was calculated, resulting in a mean difference of 0.82 mm. This first step indicates that by using 3D images, a virtual incision pattern can be created and transferred back onto the patient successfully in an easy and accurate way by using a template. Thereafter, 3D hand images of 3 syndactyly patients were made, and individual virtual incision patterns were created. Each pattern was transferred onto the patient by using a 3D printed template. The resulting incision pattern needed minor modifications by the surgeon before the surgery was performed. Further research and validation are necessary to develop the virtual planning of desyndactylization procedures.

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CT angiography-guided single-stage release of adjacent webspaces in non-Apert syndactyly

Abstract: IV.

Cited by 7 publications

References 27 publications

The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment

The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment

Preoperative MRI Evaluation of Hand Vessels in Children With Congenital Syndactyly Malformation by a Contrast-Enhanced Three-Dimensional Water-Selective Cartilage Scan

Virtual Incision Pattern Planning using Three-Dimensional Images for Optimization of Syndactyly Surgery

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