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

Abstract

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.

Clinical Applications of Three-Dimensional Printing in Upper Extremity Surgery: A Systematic Review

“…Nevertheless, patients of the 3D-printing groups presented with good postoperative function and without increased postoperative complication rates. In syndactyly surgery, a custom-made 3D-printed silicon syndactyly model in combination with an incision pattern template was successfully used to plan desyndactylization procedures [ 25 ]. Although operation duration was not investigated in this study, the authors believe that preoperative 3D-print-assisted incision pattern planning can reduce operation duration [ 25 ].…”

“…In syndactyly surgery, a custom-made 3D-printed silicon syndactyly model in combination with an incision pattern template was successfully used to plan desyndactylization procedures [ 25 ]. Although operation duration was not investigated in this study, the authors believe that preoperative 3D-print-assisted incision pattern planning can reduce operation duration [ 25 ]. Even in challenging and complicated thumb reconstructions with second toe transplant, using 3D-printed bone and joint models revealed shorter operation duration and satisfying functional outcomes [ 26 ].…”

Comparison of Outcomes Following Syndactyly Release with Grafts and Without Grafts

“…Tissue in the web area is always deficient, and the use of skin grafts for its coverage has high rates of contracture and web creep. 14 To overcome these dis-advantages of using skin grafts at the finger base after dorsal rectangular and triangular flaps, flaps of varying designs have gained popularity. 15 Owing to its good elastic feature, the skin on the hand dorsum can be pulled freely to the webspace.…”

Treatment of congenital syndactyly

“…Despite the tremendous progress made in the medical field during the last century, especially regarding deciphering the human genome and subsequent treatments, management of such a condition remains primarily surgical. Similarly, as evidenced by a flourishing literature about surgical technique refinements and innovative resources [2], procedures have evolved over the last decades to improve functional and esthetic outcomes.…”