Primary On-top Plasty for Treatment of Short-type Postaxial Polydactyly of the Foot

Usami, Satoshi; Kodaira, Satoshi; Okazaki, Mutsumi

doi:10.1097/sap.0000000000000385

Cited by 10 publications

(8 citation statements)

References 10 publications

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“…Takagi et al (2015) performed an on-top plasty for a floating finger to achieve cosmesis with the preservation of five digits. Usami et al (2016) described their primary operation with on-top plasty for lengthening of short-type postaxial polydactyly.…”

Section: Discussionmentioning

confidence: 99%

“…On-top plasty has traditionally been recommended using a circumferential incision and mobilizing the ulnar duplicate on its neurovascular pedicle and dorsal veins to replace the distal radial duplicate. However, postoperative complications are relatively common, including swelling, a shortened new thumb, narrow first web and unpleasant dorsal scar formation (Al-Qattan and Al-Qattan, 2017; Nakarmi, 2019; Usami et al., 2016).…”

Section: Introductionmentioning

confidence: 99%

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A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

Fang

Chan

Zhou

et al. 2021

J Hand Surg Eur Vol

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Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion–extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

Fang

Chan

Zhou

et al. 2021

J Hand Surg Eur Vol

View full text Add to dashboard Cite

show abstract

“…However, there are rare forms of polydactyly that require more complex surgical procedures to achieve satisfactory correction. For example, Satosh et al ( 3 ) reported a case of polydactyly with short toe deformity that was successfully treated with an “on-top plasty” technique involving osteotomy and transfer at the phalangeal level. They were able to improve the length of the toe with this technique.…”

Section: Introductionmentioning

confidence: 99%

On-Top Plasty at the Level of the Metatarsal Neck for Treatment of Polydactyly

Liao

Zheng

2022

Front. Pediatr.

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Polydactyly is a common deformity of the limbs, and excision of the extra digit has shown good results in the vast majority of patients. However, this treatment approach may not suitable for all cases of polydactyly. Some complex surgical procedures are required to treat rare forms of polydactyly and achieve satisfactory correction. Here, we report the use of on-top plasty technique for treating polydactyly between the 4th and 5th metatarsals with concomitant angulation of the 5th metatarsophalangeal joint. We performed the first osteotomy at the neck of metatarsal bone by “grafting” the distal polydactyly with the normal axis to the 5th metatarsal bone. Excision of the extra toe was accompanied by simultaneous restoration of the 5th toe axis and decrease in the width of the forefoot. Finally, both appearance and function could be improved. With this novel method, the complete osteoarticular structure and weight-bearing structure of foot were well-reconstructed. Based on the findings, we recommend that for the surgery of polydactyly, the beneficial parts should be preserved for reconstruction, and the tailored and personalized approach could be adopted.

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“…Polydactyly of the foot is among the most common congenital anomalies of the foot. It is characterized by six toes, with or without duplication of the corresponding metatarsals or phalanges [1]. The manifestations of polydactyly of the foot may range from vestigial soft-tissue masses to an additional fully formed digit.…”

Section: Introductionmentioning

confidence: 99%

“…in polydactyly surgery because these aspects have a significant effect on the postoperative results and appearance [7,15,16]. Usami et al [1] described four cases of on-top plasty to lengthen the toe in short-type postaxial polydactyly of the foot. The procedure involved separating and elevating the fifth toe with the neurovascular bundle in the metatarsophalangeal joint (distal component), followed by transferring the elevated toe ray to the top of the remaining proximal phalanx (proximal component) of the neighboring sixth toe after osteotomy.…”

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confidence: 99%

Case-control study of the treatment of postaxial polysyndactyly of the foot: Comparison of surgical results after removal of the fifth or sixth toe

2021

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Background In postaxial polysyndactyly of the foot, the choice of which toe to excise is controversial. It is often treated by resection of the fifth toe to save the lateral neurovascular bundles of the sixth toe. However, the sixth toe is often short and laterally deviated, which may require wedge osteotomy, potentially shortening the phalanx and compromising circulation. This study outlines an individualized method to spare the length and axis of the fifth toe in polysyndactyly with a short and deviated sixth toe.Methods We retrospectively analyzed 38 patients who underwent surgery between 2006 and 2019. The fifth toe was spared in 18 cases, and the sixth toe in 20 cases. The ratios of the forefoot width, angle difference, and toe length were compared between the affected and unaffected sides postoperatively. Complications and subjective judgments on cosmetic results were recorded and compared.Results No significant between-group differences were observed for sex, age at surgery, or the follow-up period. The forefoot width ratio did not significantly differ between the groups. However, the angle difference and toe length ratios showed significantly better results in the fifth toe-spared group than in the sixth toe-spared group (P<0.05 and P<0.01, respectively). There were no cases of impaired circulation, and subjective evaluations revealed satisfactory results in the fifth toe-spared group.Conclusions In cases with short and deviated sixth toes, sparing the fifth toe is an effective method of cosmetic treatment. The surgical results were satisfactory, with an improved appearance and no residual deformities.

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Primary On-top Plasty for Treatment of Short-type Postaxial Polydactyly of the Foot

Abstract: This on-top procedure is useful for improving toe lengthening and bone alignment correction with minimal functional disturbance.

Cited by 10 publications

References 10 publications

A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

On-Top Plasty at the Level of the Metatarsal Neck for Treatment of Polydactyly

Case-control study of the treatment of postaxial polysyndactyly of the foot: Comparison of surgical results after removal of the fifth or sixth toe

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