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Long-Term Outcomes Following Radial Polydactyly Reconstruction
REFERENCES 1. Ali M, Jackson T, Rayan GM. Closing wedge osteotomy of abnormal middle phalanx for clinodactyly. J Hand Surg Am. 2009;34(5):914e918. 2. Bednar MS, Bindra RR, Light TR. Epiphyseal bar resection and fat interposition for clinodactyly. J Hand Surg Am. 2010;35(5):834e837. 3. Caouette-Laberge L, Laberge C, Egerszegi EP, Stanciu C. Physiolysis for correction of clinodactyly in children. J Hand Surg Am. 2002;27(4):659e665. 4. Strauss NL, Goldfarb CA. Surgical correction of clinodactyly: two straightforward techniques. Tech Hand Up Extrem Surg. 2010;14(1):54e57.
PAPER 26 Clinical Paper Session 04: Pediatrics Friday, September 19, 2014 10:19e10:26 AM Category: Treatment, Surgical Technique, Prognosis/Outcomes Keyword: Hand and Wrist, Congenital and Pediatric Problems
Long-Term Outcomes Following Radial Polydactyly Reconstruction Level 4 Evidence
© Chris Stutz, MD Hypothesis: Radial polydactyly is a common congenital condition that largely occurs in a sporadic distribution. It is generally accepted that reconstruction rather than simple excision is the treatment of choice in the majority of cases, but few long-term outcome studies exist in the literature. The purpose of the current investigation is to report long-term outcomes (greater than 10 years) following radial polydactyly reconstruction. Methods: We evaluated 43 surgically reconstructed thumbs in 41 patients with radial polydactyly who had follow-up greater than 10 years. The study group included 12 Flatt type II, 8 type III, 17 type IV, and 6 type V. The average age of surgery was 1 year, with a mean follow-up of 17 years. Objective outcome values as well as validated patient-oriented outcome evaluations were obtained. Results: No early post-surgical complications were encountered. 8 patients had 10 revision procedures at an average of 8 years following the initial procedure. 5 patients had interphalangeal joint fusion, all for angulation with accompanying pain. The average Tada score was 4.1, lateral pinch was 96% of unaffected side, tripod pinch was 86% of unaffected side, and tip pinch was 92% of the unaffected side. As a group, operative thumbs had significantly weaker tip and tripod pinch strengths than nonoperative thumbs. The average DASH score was 4.5 and the average PedsQL score was 87 when administered to the patient and 86.8 when administered to the parent. Summary: We found that long-term results following surgical reconstruction for radial polydactyly are excellent, but the revision rate trends upward over time despite maintaining favorable scores on the objective outcome measures utilized.
PAPER 27 Clinical Paper Session 04: Pediatrics Friday, September 19, 2014 10:26e10:33 AM Category: Treatment, Surgical Technique, Prognosis/Outcomes Keyword: Hand and Wrist, Congenital and Pediatric Problems, Diseases and Disorders
cosmetic outcomes and complications. A graftless technique with an advanced Hyaluronic Acid (HA) scaffold used to cover the bare areas has been developed. Methods: Between December 2008 and December 2012, release of 42 webs in 38 hands of 36 children with different types of complete syndactyly was performed using an advanced HA scaffold to cover the skin defects. Mean age at surgery was 38 months. One patient was excluded due to early postoperative infection that required HA scaffold removal. Mean follow-up of the remaining group was 28 months. Web creep, secondary deformities, scar quality and patients and parental satisfaction were assessed. Results: All patients had close to normal pigmentation and good pliability at the sites of HA scaffold application. There were no secondary deformities and minimal degree of web creep at follow-up. There were no hypertrophic scars or keloids. All patients and parents stated to be satisfied by the avoidance of skin grafts. Summary Points: this technique allows to avoid skin grafting (absent donor site morbidity) this is a time effective procedure, with a reduced anaesthetic and operating time, that may contribute to reduce the related risks and social costs any size skin defects may be covered with the HA scaffold the results confirm the use of a HA scaffold as a promising alternative to skin grafting in syndactyly release surgery. REFERENCES 1. Chen WY, Abatangelo G. Functions of hyaluronan in wound repair. Wound Repair Regen. 1999;7:79e89. 2. Longaker MT, Chiu ES, Adzick NS, Stern M, Harrison MR, Stern R. Studies in fetal wound healing. V. A prolonged presence of hyaluronic acid characterizes fetal wound fluid. Ann Surg. 1991;213:292e296. 3. Manuskiatti W, Maibach HI. Hyaluronic acid and skin: wound healing and aging. Int J Dermatol. 1996;35:539e544. 4. Myers SR, Partha VN, Soranzo C, Price RD, Navsaria HA. Hyalomatrix: a temporary epidermal barrier, hyaluronan delivery, and neodermis induction system for keratinocyte stem cell therapy. Tissue Eng. 2007;13:2733e2741. 5. Tamisani AM. The use of hyalomatrix in deep paediatric burns. Annals of Burns and Fire Disasters. 2004;17(4):193e196. 6. Lees VC, Fan TP, West DC. Angiogenesis in a delayed revascularization model is accelerated by angiogenic oligosaccharides of hyaluronan. Lab Invest. 1995;73(2):259e266. 7. Harty M, Neff AW, King MW, Mescher AL. Regeneration or scarring: an immunologic perspective. Dev Dyn. 2003;226(2):268e279. 8. Draaijers LJ, Tempelman FR, Botman YA, et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113(7):1960e1965. discussion 1966e1967. 9. Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995;16(5):535e538. 10. Campoccia D, Hunt JA, Doherty PJ, et al. Quantitative assessment of the tissue response to films of hyaluronan derivatives. Biomaterials. 1996;17(10): 963e975.
PAPER 28 Clinical Paper Session 04: Pediatrics Friday, September 19, 2014 10:33e10:40 AM Category: Treatment, Historical Information, Prognosis/Outcomes Keyword: Congenital and Pediatric Problems
The Natural History of Pediatric Trigger Thumb Level 4 Evidence
Hyaluronic Acid Scaffold for Skin Defects Closure in Congenital Syndactyly Release Surgery Level 4 Evidence
© © © ©
Lorenzo Garagnani, MD Mario Lando, MD Andrea Leti Acciaro, MD Antonio Landi, MD
Hypothesis: Several techniques for congenital syndactyly release have been described. Some techniques require skin grafting, which might lead to poor
© Speaker has nothing of financial value to disclose
© Douglas T. Hutchinson, MD © Sarah Al-Obaydi, MBChB, MPH Hypothesis: Observational treatment of pediatric trigger thumbs has merit and should be offered to families though the cure rate in USA patients is far different from that of our Korean colleagues. Methods: We prospectively followed a nearly consecutive group (only 6 declined) of 101 patients with 122 pediatric trigger thumbs for 4-5 years. Data included goniometric evaluation of the IPj flexion and angulation contracture and MPj hyperextension of both affected and unaffected
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PAPER 26 Clinical Paper Session 04: Pediatrics Friday, September 19, 2014 10:19e10:26 AM Category: Treatment, Surgical Technique, Prognosis/Outcomes Keyword: Hand and Wrist, Congenital and Pediatric Problems
Long-Term Outcomes Following Radial Polydactyly Reconstruction Level 4 Evidence
© Chris Stutz, MD Hypothesis: Radial polydactyly is a common congenital condition that largely occurs in a sporadic distribution. It is generally accepted that reconstruction rather than simple excision is the treatment of choice in the majority of cases, but few long-term outcome studies exist in the literature. The purpose of the current investigation is to report long-term outcomes (greater than 10 years) following radial polydactyly reconstruction. Methods: We evaluated 43 surgically reconstructed thumbs in 41 patients with radial polydactyly who had follow-up greater than 10 years. The study group included 12 Flatt type II, 8 type III, 17 type IV, and 6 type V. The average age of surgery was 1 year, with a mean follow-up of 17 years. Objective outcome values as well as validated patient-oriented outcome evaluations were obtained. Results: No early post-surgical complications were encountered. 8 patients had 10 revision procedures at an average of 8 years following the initial procedure. 5 patients had interphalangeal joint fusion, all for angulation with accompanying pain. The average Tada score was 4.1, lateral pinch was 96% of unaffected side, tripod pinch was 86% of unaffected side, and tip pinch was 92% of the unaffected side. As a group, operative thumbs had significantly weaker tip and tripod pinch strengths than nonoperative thumbs. The average DASH score was 4.5 and the average PedsQL score was 87 when administered to the patient and 86.8 when administered to the parent. Summary: We found that long-term results following surgical reconstruction for radial polydactyly are excellent, but the revision rate trends upward over time despite maintaining favorable scores on the objective outcome measures utilized.
PAPER 27 Clinical Paper Session 04: Pediatrics Friday, September 19, 2014 10:26e10:33 AM Category: Treatment, Surgical Technique, Prognosis/Outcomes Keyword: Hand and Wrist, Congenital and Pediatric Problems, Diseases and Disorders
cosmetic outcomes and complications. A graftless technique with an advanced Hyaluronic Acid (HA) scaffold used to cover the bare areas has been developed. Methods: Between December 2008 and December 2012, release of 42 webs in 38 hands of 36 children with different types of complete syndactyly was performed using an advanced HA scaffold to cover the skin defects. Mean age at surgery was 38 months. One patient was excluded due to early postoperative infection that required HA scaffold removal. Mean follow-up of the remaining group was 28 months. Web creep, secondary deformities, scar quality and patients and parental satisfaction were assessed. Results: All patients had close to normal pigmentation and good pliability at the sites of HA scaffold application. There were no secondary deformities and minimal degree of web creep at follow-up. There were no hypertrophic scars or keloids. All patients and parents stated to be satisfied by the avoidance of skin grafts. Summary Points: this technique allows to avoid skin grafting (absent donor site morbidity) this is a time effective procedure, with a reduced anaesthetic and operating time, that may contribute to reduce the related risks and social costs any size skin defects may be covered with the HA scaffold the results confirm the use of a HA scaffold as a promising alternative to skin grafting in syndactyly release surgery. REFERENCES 1. Chen WY, Abatangelo G. Functions of hyaluronan in wound repair. Wound Repair Regen. 1999;7:79e89. 2. Longaker MT, Chiu ES, Adzick NS, Stern M, Harrison MR, Stern R. Studies in fetal wound healing. V. A prolonged presence of hyaluronic acid characterizes fetal wound fluid. Ann Surg. 1991;213:292e296. 3. Manuskiatti W, Maibach HI. Hyaluronic acid and skin: wound healing and aging. Int J Dermatol. 1996;35:539e544. 4. Myers SR, Partha VN, Soranzo C, Price RD, Navsaria HA. Hyalomatrix: a temporary epidermal barrier, hyaluronan delivery, and neodermis induction system for keratinocyte stem cell therapy. Tissue Eng. 2007;13:2733e2741. 5. Tamisani AM. The use of hyalomatrix in deep paediatric burns. Annals of Burns and Fire Disasters. 2004;17(4):193e196. 6. Lees VC, Fan TP, West DC. Angiogenesis in a delayed revascularization model is accelerated by angiogenic oligosaccharides of hyaluronan. Lab Invest. 1995;73(2):259e266. 7. Harty M, Neff AW, King MW, Mescher AL. Regeneration or scarring: an immunologic perspective. Dev Dyn. 2003;226(2):268e279. 8. Draaijers LJ, Tempelman FR, Botman YA, et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113(7):1960e1965. discussion 1966e1967. 9. Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995;16(5):535e538. 10. Campoccia D, Hunt JA, Doherty PJ, et al. Quantitative assessment of the tissue response to films of hyaluronan derivatives. Biomaterials. 1996;17(10): 963e975.
PAPER 28 Clinical Paper Session 04: Pediatrics Friday, September 19, 2014 10:33e10:40 AM Category: Treatment, Historical Information, Prognosis/Outcomes Keyword: Congenital and Pediatric Problems
The Natural History of Pediatric Trigger Thumb Level 4 Evidence
Hyaluronic Acid Scaffold for Skin Defects Closure in Congenital Syndactyly Release Surgery Level 4 Evidence
© © © ©
Lorenzo Garagnani, MD Mario Lando, MD Andrea Leti Acciaro, MD Antonio Landi, MD
Hypothesis: Several techniques for congenital syndactyly release have been described. Some techniques require skin grafting, which might lead to poor
© Speaker has nothing of financial value to disclose
© Douglas T. Hutchinson, MD © Sarah Al-Obaydi, MBChB, MPH Hypothesis: Observational treatment of pediatric trigger thumbs has merit and should be offered to families though the cure rate in USA patients is far different from that of our Korean colleagues. Methods: We prospectively followed a nearly consecutive group (only 6 declined) of 101 patients with 122 pediatric trigger thumbs for 4-5 years. Data included goniometric evaluation of the IPj flexion and angulation contracture and MPj hyperextension of both affected and unaffected
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