Congenital Syndactyly: Surgical Treatment of 332 Webspaces
David L. Colen, M.D., Brianne Mitchell, MD, Marten N. Basta, BS, John P. Fischer, MD, Benjamin Chang, MD.
University of Pennsylvania, Philadelphia, PA, USA.
To evaluate the demographics, surgical technique and operative results of congenital syndactyly repair and to determine which factors are predictive of postoperative complications and reoperation.
This is a retrospective review of patients who underwent repair of congenital syndactyly from 1999-2012 by the senior author. Data included patient demographics, medical history (including syndromic diagnoses), anatomic involvement, complexity of defect, surgical technique, staging of repair, postoperative follow up and the need for operative revision. Univariate and logistic regression analysis uncovered factors which were associated with the primary outcome, post-operative wound complications.
In 139 patients (average age 6.5 years), 20.1% carried a syndromic diagnosis and systemic comorbidities were uncommon (6.8%). Syndactyly involved the left hand in 74%, right hand in 68%, and was bilateral in 42% of patients. 167 cases were included with only 23 wound complications after initial surgery and 38 complications total, most commonly contracture deformity (n=18) and web creep (n=7). Reoperative revision was required in 8 patients after their initial surgery (5.8%). Adjusted regression analysis demonstrated 4 independent predictors of postoperative wound complications: need for skin graft (OR=6.54, p=0.021), oligodactyly of the affected hand (OR=3.81, p=0.044), prior hand surgery (OR=2.92, p=0.072), and two or more elective hand procedures (OR=4.12, p=0.004).
We describe our surgical experience at a high throughput children’s hospital based on epidemiologic characteristics, surgical treatment and postoperative course. There is evidence to suggest that patients with certain complicated presentations and complex surgical treatments are at higher risk of developing postoperative complications requiring further surgery.
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