Skin Graftless Dorsal Metacarpal Island VY Advancement Flap versus Dorsal Rectangular Flap with Skin Grafting in 213 Simple Syndactyly Releases.

IF 3.2 2区医学 Q1 SURGERY

Plastic and reconstructive surgery Pub Date : 2025-06-01 Epub Date: 2024-12-17 DOI:10.1097/PRS.0000000000011925

Shaun D Mendenhall, Emily M Graham, Zoe E Belardo, Eliza Buttrick, Elizabeth B Card, Apurva S Shah, Benjamin Chang

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引用次数: 0

Abstract

Background: Simple syndactyly is a common congenital upper extremity difference. Traditional reconstructive approaches use skin grafts; however, recent studies suggest that skin graftless techniques may improve outcomes. The authors hypothesized that patients who underwent reconstruction with a skin graftless dorsal metacarpal island VY advancement flap would have fewer postoperative complications compared with those released with a dorsal rectangular flap with skin grafts.

Methods: Patients aged 0 to 17 years presenting for primary reconstruction of simple syndactyly were analyzed retrospectively at a large pediatric hospital. Medical records were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes, CPT codes, and case logs from 6 hand surgeons. Outcomes of interest included early postoperative complications (within 30 days) such as infection, hematoma, seroma, wound healing issues, unplanned returns to the operating room, and digit loss. Late complications (>30 days) included web creep and development of pathologic scar formation.

Results: In total, 213 syndactyly repairs from 153 patients were analyzed (rectangular, 94 webspaces and 58 patients; VY, 119 webspaces and 95 patients). The rectangular group had significantly more early complications ( P = 0.04). The rectangular group had significantly higher incidences of web creep and hypertrophic scarring (19.3% versus 1.8%, P < 0.001; 19.1% versus 5.9%, P = 0.003, respectively). The rectangular flap with skin grafts was the only variable predictive of web creep and hypertrophic scar formation on regression analysis ( P < 0.001 and P = 0.004, respectively). Subgroup analyses of syndromic and nonsyndromic cases and incomplete and complete cases mirrored overall cohort results.

Conclusion: Simple syndactyly releases with the skin graftless technique produces fewer complications compared with the traditional approach with skin grafts.

Clinical question/level of evidence: Therapeutic, III.

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无皮掌背岛型VY推进皮瓣与背侧矩形皮瓣联合皮移植治疗单纯并指松解213例。

背景介绍单纯性联合畸形是一种常见的先天性上肢畸形。传统的重建方法使用植皮；但最近的研究表明，无植皮技术可能会改善治疗效果。我们假设，与使用带植皮的背侧矩形皮瓣的患者相比，使用无植皮背侧掌骨岛状 VY 推进皮瓣进行重建的患者术后并发症较少：方法：对一家大型儿科医院的 0-17 岁单纯腕关节联合畸形初次重建患者进行了回顾性分析。通过 ICD-9/10 编码、CPT 编码和六名手外科医生的病例记录确定了医疗记录。研究结果包括术后早期并发症（30 天内），如感染、血肿、血清肿、伤口愈合问题、计划外返回手术室和手指缺失。晚期并发症（超过30天）包括蹼蠕动和病理性疤痕形成：共分析了153名患者的213例联合畸形修复（矩形=94个蹼，58名患者；VY=119个蹼，95名患者）。矩形组的早期并发症明显较多（P=0.04）。矩形组的蹼间蠕变和增生性瘢痕发生率明显更高（19.3% vs 1.8%，P=0.04）：与使用植皮的传统方法相比，使用无植皮技术进行简单的联合畸形松解术产生的并发症更少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.