A Novel Method of Using Mini External Fixator for Maintaining Web Space After the Release of Contracture and Syndactyly

Abstract

Syndactyly and postburn contracture of the digits are the common cases seen in a hand clinic. Their management can be roughly divided into 3 stages. In stage 1, syndactyly/postburn contracture of the digits are surgically released; in stage 2, surgical wound care is provided; and in stage 3, the patient undergoes physiotherapy (rehabilitation). The most common method of immobilizing the digit after the release is by plaster of Paris splints. Its demerit includes loss of correction, painful postoperative dressing, and suboptimal graft uptake due to improper immobilization and maceration. We describe a simple and effective method of mitigating the above-mentioned drawbacks using a mini external fixator, after the release of the contracted fingers. The use of this fixator also helps during the surgery (stage 1) as resurfacing of the raw areas becomes quick because 2 surgeons can perform this simultaneously. The web can be further opened up using the fixator to facilitate the suturing of the FTG/flap, after which it can be brought back to its normal position. As the dimension of the raw area created is fully defined it becomes easier to suture the flap/graft with appropriate tension and tie-over dressing. The postoperative dressings become easier and pain free. The maceration of the skin graft and skin margin is reduced as the compressive dressing can be applied to individual fingers rather than a collective dressing. It is advantageous even in stage 3 as it allows the surgeon to customize the splint for each finger.

Novel Use of Pennig External Fixation for the Treatment of Pediatric Syndactyly

“…The novelty of our treatment lies in the use of microexternal fixation. Previous research by Gudushiauri and Tvaliashvili, 7 Shevtsov and Danilkin, 8 Kamath et al, 9 and Mei et al, 14 introduced different external fixation mechanisms that stretch the skin and subcutaneous tissue. On the basis of the Ilizarov tensionstress rule theory, 6 when tissue is exposed to sustained tension it expands through active growth and regeneration, just like bone expansion.…”

“…On the basis of the Tension-Stress rule, 6 researchers have been able to obtain sufficient skin by stretching the intervening web space between the syndactyly digits through internal or external fixtures, avoiding the need for skin grafting. [7][8][9] In this study we propose a novel method of use of the Pennig external fixation frame (Fig. 3), applying it in such a way so as to minimize osteum damage while maximizing soft tissue expansion for syndactyly treatment.…”

Congenital Anomalies of the Upper Extremity

“…Three dorsal-ventral pairs of tendon primordia progressively develop within each limb segment [ 170 ]. The tendon primordia, which includes connective tissue cells that will encase and direct the developing myocytes, forms under the infl uence of axis-related signals and initially is independent from the infl uence of migrating myocytes [ 171 ].…”

“…For example, Wnt7a from the dorsal ectoderm regulates dorsal tendon formation and mice that lack En-1 , the transcription factor that limits Wnt7a expression to the dorsal ectoderm, develop a symmetrical bi-dorsal phenotype, i.e., dorsal or extensor tendons for both the dorsal and "ventral" aspects of the limb [ 62 , 65 ]. However, muscle interaction is an absolute require- ment for maintenance of the tendon primordia and the fi nal muscle arrangement; in muscle defi cient limbs, the tendons form but then degenerate [ 170 ].…”

“…Recently, Kamath et al [ 170 ] describe the use of a mini Complications associated with graft use have led to the development of fl aps that aim to minimize the surface area required for grafting. More recently, there has been a trend towards syndactyly repair without skin grafts.…”