[Callus distraction for lengthening of mid-hand and finger stumps in congenital hand abnormalities--personal results and review of the literature].
Distraction-lengthening technique is quite useful in a variety of congenital hand deformities with hypoplastic, or primary normal but secondary shortened (constriction ring syndrome) finger rays. It appears that around the age of two years is the earliest practical time to start distraction; certainly distraction and secondary surgical procedures to improve function should be completed before school entry age whenever possible. Between June 1990 and March 1993, nine distraction lengthening procedures (5 thumbs, 1 index, 3 little fingers) in five patients presenting with congenital hand deformities, were carried out. Although restoring length to the finger, lengthening does not provide normal circumference or, of course, interphalangeal joint motion. Amelioration in function seems to be more important than the esthetic gain. Distraction lengthening tolerates only few errors of indication, operative technique, and/or postoperative management. A high compliance of the patient and her/his parents as well as a close follow-up by an experienced surgeon, are mandatory for a good result. A variety of possible complications have been described. Generally, complication risk increases in cases of simultaneous and multiple level lengthening. Provided adequate operative technique and postoperative care, superficial pin infection and fracture in the region of distraction are the major complications. Contrary to adults, sufficient bone formation by distraction is the rule in children. Therefore, the distraction-lengthening technique is preferred to the distraction-interposition technique in the treatment of congenital hand deformities. The latter should only be used as a salvage procedure in the rare cases of insufficient callus formation. Because of the missing growth potential and reduced joint mobility, distraction lengthening is the therapy of second choice when compared to microvascular second toe transplantation.
Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Schwerverbrannten Zentrum, Medizinischen Hochschule Hannover.
R
R
Hierner
K
K
Wilhelm
B
B
Brehl
D000168:Acrocephalosyndactylia / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005385:Fingers / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006228:Hand Deformities, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D013576:Syndactyly / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome