Keloid Formation Resulting in Acquired Syndactyly of an Initially Normal Web Space Following Syndactyly Release of an Adjacent Web Space

Abstract

We present a case of acquired syndactyly secondary to keloid formation in a previously normal web space following release of syndactyly in the adjacent web space.

Keloid formation after syndactyly release in patients with associated macrodactyly: management with methotrexate therapy

“…Case 1 received a 6-month postoperative course as anti-keloid prophylaxis during surgery for the remarkable occurrence of spontaneous syndactyly of the second web after irritation from a garment during treatment of keloid formation in the third web. This case of spontaneous syndactyly has previously been published (Tonkin et al, 2008). The details are repeated in this report in order to present our experience using methotrexate to treat or prevent keloid formation at the time of syndactyly release of digits with overgrowth.…”

“…The success of methotrexate in the treatment of keloids was first reported by Onwukwe (1980) and has since been used for keloid inhibition after syndactyly release, specifically in the setting of digital enlargement (Muzaffar et al, 2004; Tonkin et al, 2008). All four of the patients we report were given methotrexate to good effect.…”

“…Their occurrence on the hands and feet is rare (Datubo-Brown, 1990; Marneros and Krieg, 2004). Keloids after operations for congenital deformities of the hands and feet are especially uncommon although isolated cases after syndactyly release in the hands or feet have been reported (Endo et al, 1995; Karpf et al, 1993; LeFlore and Antoine, 1991; Tonkin et al, 2008; Wood, 1992), particularly in the setting of macrodactyly (Muzaffar et al, 2004).…”

Surgical excision and skin grafting combined with intralesional injection of triamcinolone for the treatment of keloids after syndactyly release

“…The commonly used keloid injection drugs include corticosteroids (triamcinolone acetonide and betamethasone), 5-fluorouracil, verapamil and bleomycin (Kim et al., 2020; Klomparens and Simman, 2022; Sun et al., 2021). Successful outcomes after methotrexate administration have also been reported, although close monitoring is required because of the various systematic side effects of this drug (Kong et al., 2012; Muzaffar et al., 2004; Tolerton and Tonkin, 2011; Tonkin et al., 2008; Widerberg and Rosberg, 2019). Despite all the measures taken, some keloid recurrence seems to be inevitable, as seen in the three cases in our study of keloid relapse even after triamcinolone acetonide injection.…”

Surgical results from treating children with syndactyly through the collective effort system at “SOS Hand Recife” between 2005 and 2009

“…Good results from surgical treatment of congenital syndactyly, without functional limitations of the hand, are reported in around 60%–80% of the cases. Nonetheless, esthetic abnormalities, hypertrophic scars, 19 hyperpigmentation of the skin flap used and possible flexion of the finger in contracture have been reported. 20 The cosmetic and functional results are generally excellent in simple cases.…”