Fikret EREN, Ersin ÜLKÜR, Bahattin ÇELİKÖZ, Cengiz AÇIKEL

Basit inkomplet sindaktilinin veb flebi ile tedavisi: Greftsiz bir yöntem

Bu klinik çalışmada, distalde yeterli veb dokusunun bulunduğu basit inkomplet sindaktili deformitesi subkütan pediküllü veb flebi ile deri grefti kullanılmaksızın tedavi edildi. Bitişik parmaklar dorsal ve volar tarafta yapılan longitudinal insizyonlarla açılırken, distaldeki veb flebi subkütan pedikülü üzerinde kaldırıldı ve yeni veb komissürünü oluşturmak üzere proksimale taşındı. Parmakların yan yüzleri eşit açılı olmayan Z-plastilerle primer kapatıldı. Bu yöntemle yaşları 20-22 arasında değişen, 13 erkek hastanın 15 elinde (9 sağ el, 6 sol el), 18 basit inkomplet sindaktili deformitesi tedavi edildi. Ameliyat sonrası izleme süresi 2-15 ay arasında (ortalama 8 ay) değişti. Distal interfalangeal eklem seviyesinden kaldınlan iki flepte kısmi veya tam nekroz gözlendi. Diğer olgular¬da normal eldeki veb yapısına benzer estetik ve fonksiyonel sonuçlar elde edildi. Deri greftine özgü dezavantajların olmaması, komissürün aynı kalitede bir fleple oluşturulması, oluşturulan vebin distal kenarında insizyon hattı bulunmaması, parmak yan yüzlerinin Z-plastilerle uzatılarak primer kapatılması ve flep donör alan morbiditesi bulunmaması yöntemin başlıca avantajlarıdır. Sonuç olarak, tanımlanan yöntemin seçilmiş basit inkomplet sindaktili olgularında kullanılabileceği kanaatindeyiz.

Treatment of incomplete simple syndactyly using web flap: A method without skin graft

Background and Design.- In this clinical study, incomplete simple syndactyly that has sufficient distal web tissue was repaired without skin graft by a web flap on a subcutaneous tissue pedicle. The distally localized web flap was raised on its subcutaneous tissue pedicle and transferred proximally to form new web comissure while the syndactylous fingers were released by dorsal and volar longitudinal incisions. Raw surfaces on the fingers were primarily closed using unequal angled Z-plasties. Eighteen incomplete simple syndactylies on 15 hands (9 righthand, 6 left hand) of 13 male patients aging 20 to 22 years old were treated by the described method. The postoperative follow-up period ranged between 2 to 15 months (mean 8 months). Results.- Partial or full-thickness necroses were observed in two flaps that were raised from distal interphalangeal joint level. Aesthetic and functional results similar to normal web were achieved in the other cases. Main advantages of the method are; there is no problem inherent to skin grafts, the new web comissure is formed by a flap with similar quality, there is no incision on the distal edge of the created web, the raw surfaces of the fingers are lengthened and closed primarily by Z-plasties, and there is no flap donor site morbidity. Conclusion.- We conclude that the described method could effectively be used in the treatment of selected incomplete simple syndactyly cases.

PDF

___

1.Ezaki M, Syndactyly. Green's operative hand surgery. In: Green DP, Hotchkiss RN, Pederson WC (eds); Philadelphia; Churchill Livingstone 1999; 414-429.
2.Jones NF, Upton J. Early release of syndactyly within six weeks of birth. Orthopedic Transactions 1992; 17: 360- 362.
3.Raus EE. Repair of simple syndactylism in the healthy 10. neo-newborn. Orthop Rev 1984; 13: 498-501.
4.Vickers D, Donnelly W. Corrective surgery of syndactyly without the use of skin grafts. Hand Surgery 1996; 1: 11. 203-206.
5.Ekerot L. Correction of syndactyly: advantages with a non-grafting technique and the use of absorbable skin 12. sutures. Scand J Plast Reconstr Surg Hand Surg 1999; 33: 427-431.
6.Withey SJ, Kangesu T, Carver N, Sommerlad BC. The 13. open finger technique for the release of syndactyly. J Hand Surg [Br] 2001; 26: 4-7.
7.Gudushauri OH, Tvaliashvili LA. Local epidermoplasty 14. for syndactyly. Int Orthop 1991; 15: 39-43.
8.Işık S, Selmanpakoğlu N, Açıkel C. The use of tissue expanders in syndactyly repair. Eur J Plast Surg 1996; 19; 225-228.
9.Ishikura N, Heshiki T, Kimura T, Tsukada S. Repair of complete syndactyly by tissue expansion and composite grafts. Br J Plast Surg 1995; 48: 396-400.
10.Savacı N, Hoşnuter M, Tosun Z. Use of reverse triangular V-Y flaps to create a web space in syndactyly. Ann Plast Surg 1999; 42: 540-544.
11.Sherif MM. V-Y dorsal metacarpal flap: a new technique for the correction of syndactyly without skin graft. Plast Reconstr Surg 1998; 101: 1861-1866.
12.Peker F, Tezel E. Sindaktili onarımında dorsal metakarpal arter pediküllü flepler. Türk Plast Rekonstr Est Cer Derg 2001; 9: 19-23.
13.Yao JM, Shong JL, Sun H, et al. Repair of incomplete simple syndactyly by a web flap on a subcutaneous tissue pedicle. Plast Reconstr Surg 1997; 99: 2079-2081.
14.Smith P, Laing H. Congenital hand deformity. Plastic maxillofacial and reconstructive surgery. In: Georgiade GS, Riefkohl R, Levin LS (eds); Baltimore; Williams and Wilkins 1997; 978-991.