Office-Based Post–Axial Polydactyly Excision in Neonates, Infants, and Children

Carpenter, Christopher L.; Cuellar, Trajan A.; Friel, Michael T.

doi:10.1097/01.prs.0000475787.67693.e7

Cited by 23 publications

(19 citation statements)

References 12 publications

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“…For a number of parents, a residual remnant is a cosmetic concern,18 whereas for others, a residual bump can get caught on clothing and other items, causing pain or bleeding 19. In our study, 42% of patients who underwent ligation ultimately requested operative correction either because of failure of autoamputation or painful neuroma.…”

Section: Discussionmentioning

confidence: 70%

Long-Term Outcomes After Treatment for Type B Ulnar Polydactyly

Goebel

Dawson

Loewenstein

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Type B ulnar polydactyly is a common congenital hand difference and can be treated with either ligation or surgical excision. There is a paucity of literature, however, evaluating long-term patient reported outcomes of these treatments. The purpose of this study was to compare the long-term outcomes after ligation and excision for the management of type B ulnar polydactyly. Methods: We created a database of patients who underwent treatment for type B ulnar polydactyly at a single pediatric health system from 2005 to 2014. We administered the Patient Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity survey to patients through telephone and assessed for their satisfaction. Results: We successfully collected outcomes from 69 of 173 eligible patients treated in infancy (40% response rate). The mean follow-up was 11.1±2.5 years, and the average age of the participant at the time of the survey was 11.7±2.6 years of age. Twenty-four patients were treated with in-office ligation and 45 underwent formal surgical excision. Ten patients who were initially treated with ligation required future treatment with surgery because of symptomatic neuroma stump or persistent polydactyly (42%). Patients who were treated with surgical excision rated significantly higher satisfaction with their treatment than those who underwent ligation (P=0.003). Patients in both cohorts rated similar satisfaction with the esthetic appearance of their hand (P=0.07). There was no significant difference in PROMIS-rated hand function between the ligation and surgical cohort (P=0.765) and treated adolescents PROMIS scores were not statistically different than age-matched controls without polydactyly. Conclusion: While ligation and surgical excision result in similar function and esthetics, patient satisfaction is higher after surgery. Furthermore, a significant number of patients fail ligation and ultimately undergo surgery for symptomatic neuroma or persistent polydactyly. Counseling parents of patients with type B ulnar polydactyly should include these considerations to assist them in selecting the best treatment for their child. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 70%

Long-Term Outcomes After Treatment for Type B Ulnar Polydactyly

Goebel

Dawson

Loewenstein

et al. 2022

Journal of Pediatric Orthopaedics

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“…Table 3 outlines their study design, OCEBM level of evidence, and alternative sources of bias. Carpenter et al 16 No complications Katz and Linder 17 No complications Leber and Gosain 11 No complications Mullick and Borschel 18 No complications Patillo and Rayan 19 No complications Singer et al 20 Flat scar (90%) Residual nubbins (10%) Comparative analyses…”

Section: Resultsmentioning

confidence: 99%

“…Also, the use of local anesthesia makes surgical excision a convenient and inexpensive procedure. 8,16,24,25 Our analysis revealed a paucity of rigorous and comparative studies of suture ligation and surgical excision for ulnar polydactyly. Small samples and a high risk of selection and specialty bias limit the results of any case series.…”

Section: Discussionmentioning

confidence: 99%

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To Tie or Not to Tie: A Systematic Review of Postaxial Polydactyly and Outcomes of Suture Ligation Versus Surgical Excision

Chopan

Sayadi

Chim

et al. 2018

Hand (New York, N,Y.)

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Background: Ulnar polydactyly is frequently encountered in the newborn nursery and is commonly treated with bedside suture ligation. However, growing concern about the complications associated with suture ligation has led some practitioners to advocate for primary surgical excision instead. Thus, we set out to compare outcomes of suture ligation and surgical excision by systematic appraisal of the literature. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was performed to identify studies published between 1950 and 2017 that described outcomes of suture ligation, surgical excision, or both. Baseline characteristics, complications, and study quality were extracted for each included article. Results: A total of 900 articles were reviewed, of which 10 studies (8 case series, 2 comparative analyses) met the inclusion criteria. There was considerable heterogeneity among the studies with respect to patient characteristics and reported outcomes. There were 2 retrospective case series of suture ligation that reported no acute complications and a variable proportion of patients with residual remnants or neuromas. Studies evaluating surgical ligation reported no acute or long-term complications, with only 1 case series reporting a small percentage of residual remnants. However, in the largest cohort analysis, the difference in complication rate was reported to be as high as 23.5% for suture ligation compared with 3% for surgical excision. Conclusions: There is a paucity of literature limiting the comparison of suture ligation and surgical excision for ulnar polydactyly. Further studies are required to determine the optimal treatment.

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“…Isolated POD often follows an autosomal dominant inheritance pattern and has in general a good perinatal outcome [3,4] . Moreover, after birth, type B POD is easily solved by office surgery [5] .…”

Section: Discussionmentioning

confidence: 99%

Self-Amputation of the Extra Digit in a Fetus with Polydactyly: First Ultrasound Demonstration

Volpe

Franchi²,

Mazzone³

et al. 2017

Fetal Diagn Ther

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We herein report the first ultrasound evidence of the self-amputation of an extra digit in case of fetal polydactyly. The prenatal evidence of fetal polydactyly is not always followed by postnatal confirmation. This is not always due to ultrasound misdiagnosis, but often to an in utero self-amputation phenomenon. We demonstrate that there is the detachment of part of the digit, leading to the evidence of a neonatal bump on the site of the prenatal extra digit. This demonstration has been possible by the direct visualization of the remnant by ultrasound.

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Office-Based Post–Axial Polydactyly Excision in Neonates, Infants, and Children

Abstract: Therapeutic, IV.

Cited by 23 publications

References 12 publications

Long-Term Outcomes After Treatment for Type B Ulnar Polydactyly

Long-Term Outcomes After Treatment for Type B Ulnar Polydactyly

To Tie or Not to Tie: A Systematic Review of Postaxial Polydactyly and Outcomes of Suture Ligation Versus Surgical Excision

Self-Amputation of the Extra Digit in a Fetus with Polydactyly: First Ultrasound Demonstration

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