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Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases.

Downey-Carmona FJ, Lagares A, Farrington-Rueda D, Lirola-Criado J - J Child Orthop (2015)

Bottom Line: In addition to this, cosmetic results are better if the nail is preserved.We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome.We believe that island-nail transfer in children obtains excellent results.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Seville, Spain, franciscoj.downey.sspa@juntadeandalucia.es.

ABSTRACT

Purpose: We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children.

Introduction: Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel-Trenaunay-Weber syndrome and Proteus syndrome. The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved.

Methods: We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure.

Results: We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively.

Conclusions: We believe that island-nail transfer in children obtains excellent results.

No MeSH data available.


Related in: MedlinePlus

Case 1: Preoperative radiographs (a) and planned incisions (b). Note the hatched area where the flap was to be transferred
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Fig1: Case 1: Preoperative radiographs (a) and planned incisions (b). Note the hatched area where the flap was to be transferred

Mentions: Surgery was performed under general anesthesia and tourniquet and fluoroscopic control. The incisions were planned to ensure proper location of the nail bed and proper final toe length (Fig. 1). First, we carefully dissected to preserve the lateral collateral artery. A longitudinal osteotomy of the dorsal aspect of the distal phalanx was performed to obtain a segment of 2–3 mm thickness with the nail complex attached (Fig. 2). Care was taken not to damage the neurovascular bundle while the osteotomy was performed. The flexor and extensor tendons were transferred to the proximal phalanx and the remaining distal phalanx was excised.Fig. 1


Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases.

Downey-Carmona FJ, Lagares A, Farrington-Rueda D, Lirola-Criado J - J Child Orthop (2015)

Case 1: Preoperative radiographs (a) and planned incisions (b). Note the hatched area where the flap was to be transferred
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4549351&req=5

Fig1: Case 1: Preoperative radiographs (a) and planned incisions (b). Note the hatched area where the flap was to be transferred
Mentions: Surgery was performed under general anesthesia and tourniquet and fluoroscopic control. The incisions were planned to ensure proper location of the nail bed and proper final toe length (Fig. 1). First, we carefully dissected to preserve the lateral collateral artery. A longitudinal osteotomy of the dorsal aspect of the distal phalanx was performed to obtain a segment of 2–3 mm thickness with the nail complex attached (Fig. 2). Care was taken not to damage the neurovascular bundle while the osteotomy was performed. The flexor and extensor tendons were transferred to the proximal phalanx and the remaining distal phalanx was excised.Fig. 1

Bottom Line: In addition to this, cosmetic results are better if the nail is preserved.We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome.We believe that island-nail transfer in children obtains excellent results.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Seville, Spain, franciscoj.downey.sspa@juntadeandalucia.es.

ABSTRACT

Purpose: We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children.

Introduction: Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel-Trenaunay-Weber syndrome and Proteus syndrome. The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved.

Methods: We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure.

Results: We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively.

Conclusions: We believe that island-nail transfer in children obtains excellent results.

No MeSH data available.


Related in: MedlinePlus