今日の臨床サポート

手の先天異常

著者: 福本恵三 埼玉慈恵病院 埼玉手外科マイクロサージャリー研究所

監修: 落合直之 キッコーマン総合病院外科系センター

著者校正/監修レビュー済:2021/09/15
参考ガイドライン:
  1. 日本形成外科学会:形成外科診療ガイドライン体幹・四肢疾患 第V編 四肢先天異常
患者向け説明資料

概要・推奨   

  1. 多指症の場合、多指症手術を行う事が推奨される(推奨度2)。
  1. 合指症の場合、合指症手術を行う事が推奨される(推奨度2
  1. 裂手症の場合、裂手症手術を行う事が推奨される(推奨度2
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
福本恵三 : 特に申告事項無し[2021年]
監修:落合直之 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行った(大きな変更なし)。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 手の先天異常とは、生下時からみられる手の異常で、さまざまな形態を呈する。
  1. 上肢先天異常の新生児の発生率は0.1~0.2%である[1]
  1. 上肢の形成は受精後約4週から始まり8週で完成する。多くの手の先天異常はこの期間に起きる。
  1. 指の数が多い多指、指が癒合する合指、指が欠損する欠指などの形態がある。
  1. 多指症(<図表><図表>)、合指症(<図表>)、裂手症(<図表>)、母指形成不全症(<図表>先天性絞扼輪症候群(<図表>)、合短指症などに分類される。
 
母指多指症

MP関節から分岐するWassel分類4型の母指多指症で橈側指が低形成である。

出典

img1:  著者提供
 
 
 
合指症

中環指が指尖まで癒合する皮膚性完全合指である。

出典

img1:  著者提供
 
 
 
裂手症

中指が欠損し、示環指間に深い裂がある1指列欠損型の裂手症である。

出典

img1:  著者提供
 
 
 
母指形成不全

母指の完全欠損で、Blauth分類5型の母指形成不全である。

出典

img1:  著者提供
 
 
 
先天性絞扼輪症候群

絞扼輪と指尖合指をみる先天性絞扼輪症候群である
a:手背部
b:手掌部

出典

img1:  著者提供
 
 
 
横軸形成障害(合短指症)

短指と合指をみる横軸形成障害である。

出典

img1:  著者提供
 
 
 
  1. 遺伝性が認められるものもあるが、多くは家族歴がない散発例である。Hox遺伝子、T-Box遺伝子の関与が確認されている[2][3]
  1. 他の先天異常と合併するものがある。
問診・診察のポイント  
問診:
  1. 妊娠経過、出生時の状態、家族歴、発育の状態、他の先天異常の有無を確認する。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

最新のエビデンスに基づいた二次文献データベース「今日の臨床サポート」。
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文献 

著者: S A Temtamy, V A McKusick
雑誌名: Birth Defects Orig Artic Ser. 1978;14(3):i-xviii, 1-619.
Abstract/Text
PMID 215242  Birth Defects Orig Artic Ser. 1978;14(3):i-xviii, 1-619・・・
著者: J Zákány, D Duboule
雑誌名: Nature. 1996 Nov 7;384(6604):69-71. doi: 10.1038/384069a0.
Abstract/Text The morphogenesis of mammalian digits requires the function of several genes of the HoxD complex during development of limb buds. Using embryonic stem (ES) cells and a site-specific recombination system (loxP/Cre), we have induced a deficiency that eliminates the products of the Hoxd-13, Hoxd-12 and Hoxd-11 genes simultaneously. A Hoxd-11/lacz reporter gene replaced the deleted region in order to monitor the effect of this triple inactivation at the cellular level. Mice homozygous for this deficiency showed small digit primordia, a disorganized cartilage pattern and impaired skeletal mass. These alterations are similar to the defects seen in a human synpolydactyly, suggesting that this syndrome, which is associated with a subtle mutation in HOXD13 (ref. 8), may involve the loss of function of several Hoxd genes. These results indicate the existence of a functional hierarchy among these genes and provide us with an animal model to study human digit malformations.

PMID 8900279  Nature. 1996 Nov 7;384(6604):69-71. doi: 10.1038/384069・・・
著者: S I Agulnik, V E Papaioannou, L M Silver
雑誌名: Genomics. 1998 Jul 1;51(1):68-75. doi: 10.1006/geno.1998.5278.
Abstract/Text The T-box gene family has been conserved throughout metazoan evolution and codes for putative transcription factors that share a uniquely defining DNA-binding domain. We have previously uncovered six mouse T-box genes with discrete spatial and temporal patterns of expression during embryogenesis. Here, we report a novel mouse T-box gene, Tbx15. The Tbx15 gene produces a 3.7-kb transcript with an open reading frame coding for a polypeptide with 602 amino acid residues. Phylogenetic analysis places the Tbx15 gene into a T-box subfamily that also includes mouse Tbx1, Drosophila H15, and nematode Ce-tbx-12 genes. We have mapped mouse Tbx15 to chromosome 3, at a position 49 cM from the centromere. During development, Tbx15 transcripts are first detected at embryonic day 9.5. The gene is expressed primarily in the cranio-facial region and in the developing limbs. An isolated human homolog, TBX15, has been mapped by in situ hybridization to chromosomal band 1p13. TBX15 appears to be an excellent candidate for the dominantly expressed acromegaloid facial appearance syndrome, which also maps to the short arm of human chromosome 1 and, like TBX15, is expressed prominently in the eyebrow regions.

Copyright 1998 Academic Press.
PMID 9693034  Genomics. 1998 Jul 1;51(1):68-75. doi: 10.1006/geno.199・・・
著者: A B Swanson
雑誌名: J Hand Surg Am. 1976 Jul;1(1):8-22. doi: 10.1016/s0363-5023(76)80021-4.
Abstract/Text The classification for congenital limb malformations adopted by the American Society for Surgery of the Hand, the International Federation of Societies for Surgery of the Hand, and the International Society of Prosthetics and Orthotics is presented. This method groups similar patterns of deficiencies according to the parts that have been primarily affected by certain embryological failures, whether the insult involves a total part (skeletal and soft tissue) or only the dermomyofascial structures. The main categories of this classification are (I) failure of formation of parts. (II) failure of differentiation (separation) of parts, (III) duplication, (IV) overgrowth, (V) undergrowth, (VI) congenital constriction band syndrome, and (VII) generalized skeletal abnormalities. The rationale and method of use of the classification are discussed. This method has been tested and used in a variety of centers and has been found to be properly conceived and practical.

PMID 1021591  J Hand Surg Am. 1976 Jul;1(1):8-22. doi: 10.1016/s0363-・・・
著者: J H Dobyns, P R Lipscomb, W P Cooney
雑誌名: Clin Orthop Relat Res. 1985 May;(195):26-44.
Abstract/Text Radial polydactyly, a common congenital problem, most often occurs as thumb duplication. It appears in pentadactylous, polydactylous, and hypoplastic hands and is simulated by complex syndactyly. Classically, there are three categories for radial polydactyly: severe hypoplasia, partial duplication, and total duplication (easily confused with pseudoduplication). The common second category is subcategorized by Wassel's seven types. Management techniques vary with these classifications. Until a decade ago, the standard recommendation was simple excision of one of the duplicates. Problems of deformity, instability, and weakness became apparent, and reconstructive options were developed. Review of a series of 54 duplicate thumbs, all surgically treated, reflects the changing pattern of reconstruction. With current techniques, good results are usual, although secondary reconstructive procedures may be required. Simple excision is seldom indicated. Combination procedures, involving core tissues of bone, joint, and tendon or peripheral tissues--neurovascular, subcutaneous, and skin--or sometimes all of these, are preferred for reconstruction. The major current problem is to achieve the maximal good result with a minimal number of surgical operations.

PMID 2983920  Clin Orthop Relat Res. 1985 May;(195):26-44.
著者: K Tada, K Yonenobu, Y Tsuyuguchi, H Kawai, T Egawa
雑誌名: J Bone Joint Surg Am. 1983 Jun;65(5):584-98.
Abstract/Text Over a twenty-two-year period, 237 patients (261 hands) with duplication of the thumb were seen in the Hand Clinic of Osaka University Hospital. Two groups were identified: Group A, 141 patients without previous surgical treatment, and Group B, ninety-six patients with residual deformity despite previous surgical treatment. Using a modification of Wassel's classification, seven types of deformity were defined. In Group A these types were identified on the basis of the observed duplications of bone and soft tissue. In all but ten of the Group-B patients preoperative roentgenograms were not available and the type of deformity had to be deduced from the residual duplicated bone, the surgical scar, and the residual deformity. Surgery, performed on 193 hands (125 in Group A and sixty-eight in Group B), attempted to restore normal anatomical relationships. The results could be evaluated in 130 hands according to the range of motion, joint stability, and alignment of the remaining thumb after an average follow-up of 35.0 months. According to the rating system described, the results were rated as good in 75.5 per cent, fair in 20.2 per cent, and poor in 4.3 per cent of the ninety-four hands in Group-A patients who were followed. In the thirty-six hands of Group-B patients who could be followed, the preoperative and postoperative scores were compared. Thirteen were not improved while the other twenty-three, sixteen improved from fair to good and seven improved from poor to fair, to give a good result in 63.9 per cent of the Group-B patients who were followed. The results in these 130 Group-A and B hands emphasize the importance of providing muscle balance and, in young patients, of performing an arthroplasty of the interphalangeal or metacarpophalangeal joint when indicated, although arthrodesis was indicated as a salvage operation for Group-B patients who were more than fifteen years old.

PMID 6853563  J Bone Joint Surg Am. 1983 Jun;65(5):584-98.
著者: H Kawabata, K Tada, K Masada, H Kawai, K Ono
雑誌名: J Bone Joint Surg Am. 1990 Aug;72(7):988-98.
Abstract/Text We treated thirty-six patients (thirty-eight thumbs) who had residual deformity after ablation of a duplicated thumb. The deformities were classified into three groups: interphalangeal (eight thumbs), metacarpophalangeal (sixteen thumbs), and zigzag (fourteen thumbs). The indication for operation was primarily cosmetic; only eight patients had a functional disability, and that was mild. At the most recent follow-up, the results were rated good except for three fair results in the group that had an interphalangeal deformity, two fair results in the group that had a metacarpophalangeal deformity, and two poor and seven fair results in the group that had a zigzag deformity.

PMID 2384517  J Bone Joint Surg Am. 1990 Aug;72(7):988-98.
著者: T Ogino, S Ishii, S Takahata, H Kato
雑誌名: J Hand Surg Am. 1996 May;21(3):478-86. doi: 10.1016/S0363-5023(96)80366-2.
Abstract/Text One hundred thirteen hands exhibiting thumb polydactyly were treated and followed up for an average of 49 months. Of these, 109 hands were treated by resection of a supernumerary hypoplastic thumb. Radial thumbs were resected in 107 hands and ulnar thumbs in 2 hands. Four hands were treated using a modified Bilhaut procedure. According to a modified Tada's evaluation, the results were evaluated as good in 97 hands, fair in 12 hands, and poor in 4 hands. Patients and/or their parents were satisfied with the results in 100 hands and dissatisfied with the results in 13 hands. The factors that influenced the surgical results were analyzed. The incidence of unsatisfactory results was relatively high in Wassel types 3, 5, and 6 and triphalangeal-type thumb polydactyly. It was higher when the ulnar digit was removed than when the radial digit was removed. The results for those patients treated between 1983 and 1991 were better than for those treated between 1976 and 1982. The type of deformity, type of procedure, and skillfulness of the surgeon were factors in the results after surgery.

PMID 8724483  J Hand Surg Am. 1996 May;21(3):478-86. doi: 10.1016/S03・・・
著者: J C Cheng, K M Chan, G F Ma, P C Leung
雑誌名: J Hand Surg Am. 1984 Mar;9(2):155-64.
Abstract/Text Preaxial polydactyly constitutes the most common group of congenital anomalies of the hand among the Chinese population of Hong Kong. Ninety-five cases from the Orthopaedic/Plastic and Reconstructive Surgery Unit, Princess Margaret Hospital, Hong Kong (March 1976 to March 1981), were reviewed. The cases were classified according to Wassel's classification (1969) into seven types. The most common category was type IV followed by types II, V, III, VII, I, and VI. The treatment of each type was analyzed. Bilhaut's procedure was satisfactory for type I, and a modified technique was used for types II and III. A method of shaving the incongruous articular cartilage was used in type IV. Removal of the extra digit and osteotomy of the metacarpal usually were required for type V. The experience with types VI and VII was too limited for assessment. Short-term results (1 to 6 years) have been satisfactory, but follow-up until skeletal maturity to assess the ultimate functional and cosmetic results is necessary.

PMID 6715817  J Hand Surg Am. 1984 Mar;9(2):155-64.
著者: H D Wassel
雑誌名: Clin Orthop Relat Res. 1969 May-Jun;64:175-93.
Abstract/Text
PMID 4894526  Clin Orthop Relat Res. 1969 May-Jun;64:175-93.
著者: T W Marks, L G Bayne
雑誌名: J Hand Surg Am. 1978 Mar;3(2):107-16.
Abstract/Text In nine years 26 duplicated thumbs were seen in the hand clinic of a hospital for crippled children. Using a classification based on the level and degree of duplication and a knowledge of the abnormal anatomy, reconstruction was done. This surgery was done with proper skin incisions, reconstructions of the collateral ligaments, centralization of the flexor and extensor tendons, and alignment of the bones and joints by corrective osteotomies. Simple ablation or incomplete correction produced complications such as skin contractures, increased angular deformities, unstable joints, and intrinsic weakness. In all of the patients, the appearance was improved, opposition was maintained, and postoperative function was not impaired.

PMID 632540  J Hand Surg Am. 1978 Mar;3(2):107-16.
著者: C H Yen, W L Chan, H B Leung, K H Mak
雑誌名: J Orthop Surg (Hong Kong). 2006 Dec;14(3):295-302.
Abstract/Text PURPOSE: To evaluate clinical and cosmetic outcomes of reconstruction in thumb polydactyly and prognostic value of the Wassel classification.
METHODS: Between 1993 and 2000 inclusive, out of the patients with thumb polydactyly (involving 80 thumbs) operated on, 34 patients (36 thumbs) were available for review and underwent clinical and radiological assessment. Outcomes in terms of the Tada score and complications were recorded.
RESULTS: The mean age of patients at the time of operation was 2.8 (range, 0.6-47) years. The mean follow-up period was 5 (range, 2.4-10) years. According to the Wassel classification, 12 were type-II thumb polydactyly, 3 type-III, 11 type-IV, 6 type-V, one type-VI, and 3 type-VII. There was no perioperative mortality or wound infection. More than 88% of the patients were satisfied or very satisfied with functional and cosmetic outcomes. Postoperative complications such as scar hypertrophy, pulp atrophy, joint deformity, and instability were common but minor. Ridge nail deformity after the Bilhaut Cloquet procedure was amenable to secondary corrective procedures. All types of operated thumb polydactyly achieved similar mean Tada scores (14.7- 16.6 out of 20). The Wassel classification category, age, and surgical procedures were found to have no prognostic value with regard to the Tada score and presence of complications.
CONCLUSION: Surgery on thumb polydactyly is rewarding. The Wassel classification category can be used as a guide for treatment, although it fails to predict the occurrence of postoperative complications or Tada scores. Our patients' results can serve as guidelines of expected outcomes after reconstructive procedures in different sub-types of thumb polydactyly.

PMID 17200532  J Orthop Surg (Hong Kong). 2006 Dec;14(3):295-302.
著者: C C Lee, H Y Park, J O Yoon, K W Lee
雑誌名: J Hand Surg Eur Vol. 2013 Mar;38(3):272-80. doi: 10.1177/1753193412460809. Epub 2012 Sep 27.
Abstract/Text The purpose of this study is to present a treatment algorithm and a method of flexor pollicis longus tendon relocation for Wassel type IV thumb duplication with zigzag deformity. Forty-two thumbs in 42 patients were included in this study and the mean follow-up was 4 years. In addition to excision of the extra digit, tendon relocation and metacarpal and/or proximal phalangeal osteotomy were carried out, based on the degree of angulation at the metacarpophalangeal and interphalangeal joints. Tendon relocation was achieved using our pull-out suture technique. The results were assessed using an evaluation form for thumb polydactyly provided by the Japanese Society for Surgery of the Hand. At the time of latest clinical contact, eight cases were rated good, 31 cases fair, and three cases poor. It is useful to decide surgical procedures according to the degree of angulation of the metacarpophalangeal and interphalangeal joints and flexor pollicis longus tendon relocation is important to prevent malalignment at the interphalangeal joint.

PMID 23023875  J Hand Surg Eur Vol. 2013 Mar;38(3):272-80. doi: 10.117・・・
著者: Emiko Horii, Tatsuya Hattori, Syukuki Koh, Masataka Majima
雑誌名: J Hand Surg Am. 2009 Dec;34(10):1802-7. doi: 10.1016/j.jhsa.2009.07.018. Epub 2009 Nov 7.
Abstract/Text PURPOSE: To report the surgical outcomes for Wassel type III radial polydactyly thumbs of equal or nearly equal size treated by excising the radial thumb with augmentation.
METHODS: We have reconstructed 15 cases of Wassel type III radial polydactyly, in which the duplicated digits were equal or almost equal in size, by ablation of a radial digit. The distal articular surface of the radial proximal phalanx was preserved in order to maintain stability of the interphalangeal joint. The stability of the retained thumb was further augmented by tendon repositioning, restoration of the radial collateral ligament, and transfer of soft tissues from the radial digit. Eleven of 15 cases were followed up for more than 2 years and were available for assessment using the Japanese Society for Surgery of the Hand evaluation form. The average age at follow-up was 8 years and 3 months. The size of the nail and distal phalanx was measured to assess the growth of the thumb.
RESULTS: An average functional point was 12 points (maximum 14 points), and restricted interphalangeal joint motion and extension lag were the disadvantages of this technique. The width of the distal phalanx was increased from 62% of the size of the metacarpal before surgery to 78% at the final follow-up. The cosmetic score averaged 3.6 (maximum 4 points), and slightly small nails without a central ridge were deemed acceptable.
CONCLUSIONS: Our technique can provide a functionally good thumb for Wassel type III radial polydactyly.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

PMID 19897319  J Hand Surg Am. 2009 Dec;34(10):1802-7. doi: 10.1016/j.・・・
著者: Marios D Vekris, Marios G Lykissas, Panayiotis N Soucacos, Anastasios V Korompilias, Alexandros E Beris
雑誌名: Tech Hand Up Extrem Surg. 2010 Mar;14(1):2-7. doi: 10.1097/BTH.0b013e3181c660f3.
Abstract/Text Congenital syndactyly is one of the most common congenital hand differences and various methods of surgical treatment have been described since the 19th century. Nevertheless, unsatisfactory results including web creep, flexion contractures, and rotational deformities of the fingers are still reported. This study presents the outcome of syndactyly release in 131 webs in 78 patients. The sex ratio was 40 males/38 females. The age ranged from 4 months to 22 years (average: 4 y). In the majority of the webs the result was good or excellent. The type of flaps used for the reconstruction of the web was important as the combination of a dorsal rectangular and 2 volar triangular flaps gave superior results than the use of 2 triangular flaps. The less rewarding overall outcome was obtained in the presence of associated differences of the involved fingers, that is, complex complicated syndactyly and in the cases of delayed correction. Use of a dorsal rectangular flap in combination with 2 volar triangular flaps and use of full thickness skin grafts, ensure a satisfactory outcome and minimize the number of operations per web.

PMID 20216045  Tech Hand Up Extrem Surg. 2010 Mar;14(1):2-7. doi: 10.1・・・
著者: Junpei Miyamoto, Tomohisa Nagasao, Shimpei Miyamoto
雑誌名: Plast Reconstr Surg. 2010 Mar;125(3):963-8. doi: 10.1097/PRS.0b013e3181cb6743.
Abstract/Text BACKGROUND: The dorsal rectangular flap technique has been widely used for the correction of syndactyly. In this method, however, the linear scar along the palmar border of the webspace may lead to secondary contracture and web creep. Some modifications have been advocated for breaking these linear scars. In this study, these modifications were evaluated biomechanically with the finite element method.
METHODS: Based on computed tomography findings of seven adult hands, three scar models were created: the dorsal rectangular flap, the dorsal flap with palmar-based triangular flap, and the dorsal flap with V-shaped tip. Forced displacements were applied to mimic the hand-opening motion, and scar stresses and web displacement were investigated.
RESULTS: The maximal stress of the scar was significantly greater in the dorsal rectangular flap group than in the other groups (dorsal flap with palmar-based triangular flap, p = 0.046; dorsal flap with V-shaped tip, p = 0.018). The web was displaced most distally in the dorsal rectangular flap group compared with the other groups (dorsal flap with palmar-based triangular flap, p = 0.043; dorsal flap with V-shaped tip, p = 0.043). There was no significant difference between the dorsal flap with a palmar-based triangular flap group and the dorsal flap with a V-shaped tip group.
CONCLUSIONS: The authors' results indicate that both the palmar-based triangular flap and the V-shaped tip flap work well. It is strongly recommended that any break should be made in the palmar edge of the webspace for prevention of web creep.

PMID 20195122  Plast Reconstr Surg. 2010 Mar;125(3):963-8. doi: 10.109・・・
著者: Onder Tan, Bekir Atik, Duygu Ergen
雑誌名: Ann Plast Surg. 2005 Dec;55(6):623-8.
Abstract/Text The loss of web space may be congenital or acquired. Although local skin flaps are usually preferred, recurrence rate is fairly high. In this study, we used the VM-plasty as a versatile technique to create a web space and expanded its applications. Thirteen patients (7 males and 6 females) with 22 syndactylous webs were operated on using this technique. The web contractures were developed on scarred tissues in 9 patients, whereas only 4 cases presented with primary congenital syndactylies. The skin graft was not used in any of the patients. All the patients gained web functions with a good esthetic appearance without any recurrence. The technique is fairly versatile and can be used both in the hand and foot for congenital complete or incomplete syndactylies and acquired web space contractures. So, we advise the VM-plasty both in primary and recurrent cases with web space loss.

PMID 16327464  Ann Plast Surg. 2005 Dec;55(6):623-8.
著者: Cengiz Yildirim, Sadk Sentürk, Kenan Keklikçi, Ibrahim Akmaz
雑誌名: Ann Plast Surg. 2011 Oct;67(4):357-63. doi: 10.1097/SAP.0b013e3181fc055a.
Abstract/Text Skin grafts and local flaps are conventional methods of repair for congenital syndactyly, but the results obtained are not always as functional and aesthetic as desired and frequently leave postoperative scars and residual syndactyly. In this article, we describe a new surgical technique for web reconstruction in the correction of simple, incomplete syndactyly. The technique consists of a dorsal separated V-Y advancement flap and a volar triangular flap to cover the newly created web space, thus avoiding skin graft in this space. In all, 15 web spaces in 10 patients were treated using this method. A follow-up period of 6 months to 2 years showed neither recurrence of the deformity nor web creep of any degree. The technique is rapid, safe, easily performed, and reproducible and requires a single surgical procedure. It uses donor tissue identical in color, texture, and thickness, which renders acceptable cosmesis in cases of simple, incomplete syndactyly, therefore, avoiding the use of skin grafts and resulting postoperative scar contracture in the web space.

PMID 21301304  Ann Plast Surg. 2011 Oct;67(4):357-63. doi: 10.1097/SAP・・・
著者: N S Niranjan, S M Azad, A N M Fleming, S H Liew
雑誌名: Br J Plast Surg. 2005 Jan;58(1):14-21. doi: 10.1016/j.bjps.2004.05.031.
Abstract/Text This paper describes the long term results of a surgical technique used for correction of syndactyly. This technique has been practised by the senior author since 1987 and was published in 1990. The technique involves the use of a dorsal trilobed flap for the reconstruction of the commissure and zig-zag incisions for the fingers. This technique does not require the use of skin grafts. This technique has been used in 62 webs in 44 patients. In this total group, there were 30 patients of primary hand syndactyly with 40 webs. Seventeen patients of primary syndactyly with 25 webs were followed up. The follow-up of these patients ranged from 2 years to 12 years. The long term results reveal a simple, effective technique which does not require the use of skin grafts, and is associated with good functional and far superior cosmetic results.

PMID 15629162  Br J Plast Surg. 2005 Jan;58(1):14-21. doi: 10.1016/j.b・・・
著者: Hajime Matsumine, Yuichiro Yoshinaga, Osamu Fujiwara, Ryo Sasaki, Masaki Takeuchi, Hiroyuki Sakurai
雑誌名: Plast Reconstr Surg. 2011 Nov;128(5):504e-509e. doi: 10.1097/PRS.0b013e31822b696d.
Abstract/Text BACKGROUND: This study describes the use of a modified "bell-bottom" flap for treatment of partial syndactyly release that may avoid the use of skin grafting.
METHODS: A retrospective review of this procedure was performed for 12 interdigital space reconstructions. Patients were aged 1 to 5 years 6 months. The mean follow-up period was 24 months. The operations were performed to avoid skin grafting. The flap was designed in the narrow-spaced and fused interdigital region of syndactyly for preventing postoperative scar contracture and web formation.
RESULTS: Surgery was completed without skin grafting in all cases. The use of a modified flap allowed the construction of interdigital spaces with sufficient width, providing satisfactory cosmetic outcomes. No partial necrosis or complications were observed. No web formation, elevation of the interdigital space, or limited range of joint motion caused by contracture was observed during the 2-year follow-up period, and no secondary correction was needed.
CONCLUSION: The present surgical technique may be a new surgical option for web release in which fingers are fused at a level lower than the midpoint between the proximal and distal interphalangeal joints.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

PMID 22030510  Plast Reconstr Surg. 2011 Nov;128(5):504e-509e. doi: 10・・・
著者: Vivian M Hsu, James M Smartt, Benjamin Chang
雑誌名: Plast Reconstr Surg. 2010 Jan;125(1):225-32. doi: 10.1097/PRS.0b013e3181c49686.
Abstract/Text BACKGROUND: Syndactyly repairs that use full-thickness skin grafts risk graft-related complications. The dorsal V-Y advancement flap offers a method of syndactyly release that can eliminate the need for full-thickness skin grafts in some cases of simple syndactyly.
METHODS: A retrospective case series of all patients undergoing syndactyly release without skin grafting performed by the senior author (B.C.) between 1998 and 2007 was conducted. All outpatient and inpatient charts were reviewed for pertinent patient demographics and clinical outcomes, including the incidence of web creep, hypertrophic scarring, flexion contracture, infection, angulation deformity, limited range of motion, ischemia, and need for reoperation.
RESULTS: A total of 28 syndactylies were included in the study: 25 simple incomplete and three simple complete. Mean follow-up time was 4.2 years. Mean operative time was 68 minutes. Two patients (7.1 percent) experienced postoperative complications; both were corrected by subsequent revision.
CONCLUSION: The dorsal V-Y advancement flap without skin graft is an effective method of repair primarily in simple incomplete syndactyly.

PMID 19910851  Plast Reconstr Surg. 2010 Jan;125(1):225-32. doi: 10.10・・・

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