Syndactyly Release
This chapter describes in detail the surgical steps involved in syndactyly release. Details of soft tissue digit separation and skin flap transposition to form the floor of the newly created web space are discussed. Contingencies for skin shortage leading
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Joseph Y. Bakhach and Imad L. Kaddoura
Defenition
Essential Steps
1. Congenital hand deformity comprising of adherence of one or more digits in hands or feet.
Preoperative
Possible Complications 1 . Recurrence of deformity. 2. Web space creep. 3. Scar contracture at surgical site and subsequent finger deformity. 4. Devascularization.
J.Y. Bakhach, M.D. (*) Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, 11-0236, Beirut 1107 2020, Lebanon e-mail: [email protected] I.L. Kaddoura, M.D., F.A.C.S. Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, 11-0236, Beirut 1107 2020, Lebanon e-mail: [email protected]
1. X-ray of involved hand should be done to rule out bony syndactyly and fusion which will necessitate additional procedures to the ones described below. 2. Marking of opposing zigzag incisions on volar and dorsal aspects of joint skin at the site of syndactyly, as well as marking of a dorsal proximally based triangular flap at the site of the web-space commissure to be created (site is approximated from adjacent, normal web spaces). 3. In multiple-digit syndactyly, syndactyly of thumb with index fingers, as well as ring with small fingers are released first due to length discrepancy of these digits which may cause functional and growth impairment in cases of delayed reconstruction. 4. In case of multiple-digit syndactyly, release of both sides of a single digit is generally not performed so as to minimize chances of vascular impairment of the digit.
Intraoperative Details 1. Patient is placed in the supine position with the involved extremity in abduction on an arm table. 2. General anesthesia is instituted.
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_107
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J.Y. Bakhach and I.L. Kaddoura
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3. Tourniquet is applied to involved extremity if feasible, to be inflated as needed. 4. Involved extremity is prepped and draped. 5. Arm tourniquet is inflated after extravasation of arm by applying pressure. 6. Preoperative markings are followed, and incisions made dorsally to develop a dorsal flap at the site of syndactyly a zigzag incision. Volar zigzag incisions are make also following the preoperative markings, the volar and the dorsal flap incision angles face directly opposite each other. 7. Dissection of the joined soft tissue is performed to separate the two digits, taking care not to injure the digital neurovascular bundle under loop magnification. 8. When the previously joint tissue is completely separated, the dorsal proximally based triangular flap is pulled volarly and sutured to volar skin to form the floor of the web space between the separated digits. 9. Opposing zigzag (angular) volar and dorsal edges of each digit are approximated together respectively at the lateral digital edges and closed using 4-0 or 5-0 Vicryl Rapide sut
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