Congenital Syndactyly of the Fingers : A Report of Two Cases

AbstractSyndactyly is defined as the failure of separation of the digits during early gestation. It is one of the most common congenital anomalies. The incidence of syndactyly is uncertain, but estimates range from 1 in 2,500 live births. During development, the fingers are webbed. This remains so, until apoptosis and skin recession allow for formation of the digital interspaces. Full inter-digital spaces are usually present by the end of the 6th week of gestation.Here we present two patients and three hands who presented to us with syndactyly of the fingers. The first patient who was a 13 year old girl, had complete complex syndactyly between the ring and middle fingers of both hands. She underwent complete release with full thickness skin grafting in the first sitting. Six weeks later, she was reviewed and was noted to have developed scar contracture of the middle finger for which she underwent contracture release and z-plasty as a secondary procedure. In the final review at four months after the second surgery, the child was noted to have only terminal restriction of movements of the involved fingers of both hands with 'fair results' (as per the criteria of Cortez et al).The second patient was a two years old boy, who presented to us with incomplete simple syndactyly of the ring and index finger of the left hand. He was managed with percutaneous release of the syndactyly. He was reviewed after 4 months and there was full range of movement of the involved digits. He was also noted to have 'fair results' (as per the criteria of Cortez et al).As we had two different cases with a heterogenous presentation of two different types of syndactyly and who underwent different modalities of management, we are presenting it as an interesting case report in our article.

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Skin Grafting

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0007 ◽

2019 ◽

pp. 65-72

Author(s):

Stephen M. Milner

Keyword(s):

Skin Grafting ◽

Skin Grafts ◽

Full Thickness ◽

Preoperative Preparation ◽

Scar Contracture ◽

Skin Defects ◽

Full Thickness Skin ◽

Thickness Skin ◽

Contracture Release

Skin grafting is an indispensable technique used in a variety of clinical situations, including acute burns, traumatic wounds, scar contracture release, and oncological and congenital deficiencies. The author’s preferred techniques for harvesting and resurfacing various skin defects using split- and full-thickness skin grafts are described in this chapter, together with the assessment of donor and recipient sites, preoperative preparation and postoperative considerations.

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Neonatal compartment syndrome

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0159 ◽

2016 ◽

Vol 98 (7) ◽

pp. e111-e113 ◽

Cited By ~ 4

Author(s):

B Martin ◽

L Treharne

Keyword(s):

Compartment Syndrome ◽

Skin Grafting ◽

Dermal Matrix ◽

Term Outcome ◽

Long Term Outcome ◽

Left Hand ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Contracture Release

A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.

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Skin Graft

Plastic Surgery International ◽

10.1155/2012/563493 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 15

Author(s):

Ruka Shimizu ◽

Kazuo Kishi

Keyword(s):

Plastic Surgery ◽

Skin Graft ◽

Skin Grafting ◽

Present Review ◽

Skin Grafts ◽

Skin Flaps ◽

Muscle Flaps ◽

Scar Contracture ◽

Contracture Release ◽

Complex Wounds

Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use of skin flaps or muscle flaps. In the present review, we describe how to perform skin grafting successfully, and some variation of skin grafting.

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The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_37_17 ◽

2018 ◽

Vol 51 (01) ◽

pp. 054-059 ◽

Cited By ~ 2

Author(s):

Jyoshid R. Balan ◽

Shaji Mathew ◽

Pradeep Kumar ◽

Harsh Vardhan ◽

Anto Francis ◽

...

Keyword(s):

Road Traffic ◽

Donor Site ◽

Skin Grafting ◽

Associated Injuries ◽

Range Of Movement ◽

Flap Transfer ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Dorsal Metacarpal Artery ◽

Finger Skin

ABSTRACT Background: The finger skin and soft-tissue defects are reconstructive challenges due to their nature and the intricate extensor apparatus and flexors it protects. The reverse dorsal metacarpal artery (RDMA) is a time-tested option for the reconstruction of the same. Materials and Methods: A total of 14 cases of RDMA flap for finger defects involving proximal to distal phalanx were performed. Thirteen of these patients were male and one patient female and the most common mode of injury was occupational in nature followed by road traffic accident. The overall appearance was assessed for the flap and the donor site. The associated injuries and the range of motion were noted. Results: All but one flap survived completely. One patient had partial distal flap loss, which was tackled with split-thickness skin grafting. The flap size varied from 3.5 cm × 1.5 cm to 9 cm × 2 cm with mean of 6.64 cm × 1.72 cm. The mean age of the patients was 33.4 years. All the patients had acceptable aesthesis. The donor site had no complications and healed with linear scar. Conclusions: RDMA flap is a reliable flap for finger defects reconstruction. The range of movement mainly depends on the associated injury rather than flap transfer alone and to prove this we require doing analysis of range of movement in patients with flap done alone or with associated injuries.

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600 Bilateral Upper Limb Compartment Syndrome After Massive Postpartum Haemorrhage

British Journal of Surgery ◽

10.1093/bjs/znab259.702 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Payne ◽

S Elahi

Keyword(s):

Compartment Syndrome ◽

Upper Limb ◽

Unusual Case ◽

Postpartum Haemorrhage ◽

Skin Grafting ◽

Trauma Patients ◽

Capillary Refill ◽

Left Hand ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract Case Summary Upper limb compartment syndrome (ULCS) is an uncommon limb-threatening emergency occurring as a result of increased interstitial pressure within osteofascial compartments. The overwhelming majority of causes occur in one limb, with frequent causes including fractures, reperfusion injury and burns. We report the unusual case of bilateral upper limb CS in a previously well 35-year-old female secondary to massive resuscitation following postpartum haemorrhage. The patient received 7 litres of blood products and 4 litres of crystalloid over a period of 8 hours. One hour postoperatively both hands became painful and swollen. Symptoms worsened over the following hour: both forearms were tense to palpate with demonstrable pain on passive extension of bilateral wrists and digits of the left hand, and capillary refill to all digits was brisk. Creatinine kinase was measured at 4,600U/L and bilateral forearm and left-hand fasciotomies were performed. The presence of bulging muscles in both forearms and the left hand confirmed the diagnosis of compartment syndrome, and perfusion was restored to all digits after release of the compartments. The patient later underwent split thickness skin grafting to both forearms and left-hand fasciotomy wounds. After 5 weeks of hand therapy, she regained good function of both hands. Bilateral ULCS is extremely uncommon but has been reported secondary to massive resuscitation, particularly in trauma patients, and we suspect that this was the cause in our patient.

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Management and outcome in patients with post burn contracture

International Surgery Journal ◽

10.18203/2349-2902.isj20185133 ◽

2018 ◽

Vol 6 (1) ◽

pp. 42 ◽

Cited By ~ 1

Author(s):

Manu Rajan ◽

Arnav Tyagi ◽

Sanjay Dvivedi ◽

Kinnari A. V. Rawat

Keyword(s):

Skin Grafting ◽

Developed Countries ◽

Medical Sciences ◽

Reconstructive Procedures ◽

Burn Care ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Contracture Release ◽

Flap Cover ◽

Burn Contractures

Background: Post burn contractures are distressingly common and severe in developing nations and considered as a significant problem in developed countries as well. Despite advances in the overall management of burn injuries, severe post-burn contractures continue to be a formidable foe for reconstructive surgeons in developing countries.Methods: The study was carried out in Department of Surgery, Himalayan Institute of Medical Sciences, SRH University, Swami Ram Nagar, Dehradun over a period of 12months. Cases of the post burn contractures attended in the O.P.D were included in the study.Results: Contracture release with split thickness skin grafting STSG in 25 (55.5%) cases. Contracture release with STSG with flap cover was performed in 7 cases (15.5%), contracture release with K wire insertion with coverage was performed in 8 cases (17.7%) and Z plasty was performed in 5 cases (11%).Conclusions: There have been major advances in burn care in the last three decades and the mortality rates have gone down significantly. The management has shifted to improvement of functional outcome and better quality of life. Proper planning of reconstructive procedures, rehabilitation, restoration to pre-injury status and return to society are the goals that the treating team hopes to achieve.

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Activated Prothrombin Concentrates in Management of Bleeding in a Classical Hemophiliac with Inhibitor

10.1055/s-0039-1682589 ◽

1977 ◽

Author(s):

J.M. Whaun ◽

A. Kaegi

Keyword(s):

Skin Graft ◽

Conservative Management ◽

Full Range ◽

Factor Ix ◽

Split Thickness Skin Graft ◽

Management Problem ◽

Range Of Movement ◽

Thickness Skin ◽

Life Threatening ◽

Forearm Flexor

Bleeding in hemophiliacs with circulating anticoagulants is still a serious management problem. We would like to report our efforts at achieving hemostasis in a 31 year old AHF deficient severe hemophiliac with inhibitor detected in Feb. 1972. He presented with right forearm flexor compartment bleed which did not respond to conservative management with Konyne (30 u/kg q3h) and necessitated a fasciotomy to relieve compression. No hemostasis occurred until 4 hrs. post-operatively when he received his first infusion of Auto-Factor IX*, 6 vials (60 u/kg). At this time he also received blood for his shocky state. With the institution of regular infusions of Auto-Factor IX alternating with Konyne, hemorrhage was controlled. A week later a split thickness skin graft (from R. thigh) was applied. With continued infusions of mainly Auto-Factor IX (60 u/kg q6h) the grafted and donor sites healed. The patient was subsequently discharged with full range of movement in all limbs. His inhibitor levels which ranged between 1 - 3 Bethesda units/ml shortly after admission over a period of 3 weeks rose to over 100 units/ml. Six months after the episode his inhibitor levels are still over 100 units/ml. Activated prothrombin concentrates are effective in hemostatic control of life-threatening bleeding in hemophiliac patients with inhibitors.* Kindly supplied by Dr. Aaron Josephson, Travenol Laboratories, Chicago, 111. (Hyland Division).

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983 Digital Angioleiomyoma: A Rare Tumour Of the Hand

British Journal of Surgery ◽

10.1093/bjs/znab259.348 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

F Motiwala ◽

S Jivan

Keyword(s):

Blood Vessels ◽

Full Range ◽

Specific Treatment ◽

Middle Finger ◽

Differential Diagnoses ◽

Excision Biopsy ◽

Digital Artery ◽

Range Of Movement ◽

Rare Tumour ◽

Patient Reported

Abstract Introduction Angioleiomyoma is an unusual, benign tumour originating from the tunica media of blood vessels. They commonly occur in the face, neck and lower limb. It is rarely found in the hand and is not considered in the differential diagnoses of painful subcutaneous hand tumours. Case Report We present a case of a 40-year-old man with a several month history of a slow growing lump on his right middle finger. He complained of pain and difficulty flexing his finger. On examination, he had a solid tumour with normal overlying skin, on the volar ulnar border of middle phalanx with altered sensation and a positive Tinel’s along the ulnar digital nerve. Ultrasound and MRI reported a highly vascular subcutaneous tumour measuring 26x14x22mm with differential diagnoses of giant cell or peripheral nerve tumour. Intra-operatively the tumour was in continuity with the ulnar digital artery and solid in consistency. Tumour excision and microsurgical repair of the digital artery was required. Histology confirmed a well-defined nodule, composed of bundles of smooth muscle surrounding ectatic blood vessels, consistent with angioleiomyoma. On follow-up the patient reported return of full range of movement without hypersensitivity or evidence of recurrence. Conclusions Angioleiomyomas in the hand are rare. It should be considered in the differential diagnoses of painful subcutaneous tumours. Ultrasound and MRI are non-specific. Treatment is successful with excision biopsy and microsurgical repair of digital artery. Microvascular instruments should be available, and the patient consented for vein graft.

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