Transverse soft tissue distraction preceding separation of complex syndactylies.
Various surgical techniques are described for separation of syndactylies leading to good results. However, the use of standard techniques is limited in complex syndactylies with extensive bony fusion and tight soft tissues. The aim of this study was to assess the outcomes of a two-stage procedure involving progressive soft tissue distraction prior to syndactyly release. Between 1996 and 2012 we treated 168 complex syndactylies with this technique. The main indications were syndactylies in Apert syndrome. The digits were distracted through an external fixator at 0.5 mm/day. Distraction of 15-25 mm was achieved. Soft tissue distraction provided additional skin, a wider nail matrix and more bone in the form of callus. Thus subsequent modelling of the fingertips was improved, especially if they were closely fused. This technique facilitates treatment of complex cases and improves aesthetic outcome.


METHODS
Therapeutic IV.
Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany Department of Plastic Surgery, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany Department of Plastic Surgery and Hand Surgery, Technische Universität München, Munich, Germany.
J A
JA
Lohmeyer
Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
W
W
Hülsemann
Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
M
M
Mann
Department of Hand Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany r.habenicht@kkh-wilhelmstift.de.
R
R
Habenicht
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003238:Connective Tissue / Q000601:surgery*; D016267:External Fixators; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019857:Osteogenesis, Distraction; D013576:Syndactyly / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
Acrosyndactyly; apert syndrome; complex syndactyly; external fixator; soft tissue distraction