External fixation: Role in decreasing postoperative complications of complex syndactyly release - A review of 18 patients

Mickaël Artuso; Virginie Mas; Brice Ilharreborde; Keyvan Mazda; Pascal Jehanno

doi:10.1016/j.otsr.2019.05.015

External fixation: Role in decreasing postoperative complications of complex syndactyly release - A review of 18 patients

Orthop Traumatol Surg Res. 2019 Oct;105(6):1187-1191. doi: 10.1016/j.otsr.2019.05.015. Epub 2019 Jul 26.

Authors

Mickaël Artuso¹, Virginie Mas², Brice Ilharreborde², Keyvan Mazda², Pascal Jehanno²

Affiliations

¹ Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, Bd Sérurier, 75019 Paris, France. Electronic address: mickael.artuso@gmail.com.
² Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, Bd Sérurier, 75019 Paris, France.

PMID: 31353234
DOI: 10.1016/j.otsr.2019.05.015

Abstract

Background: Primary and revision surgery for complete complex congenital syndactyly (CCCS) of the hand carries a risk of complications such as web maceration, which can result in flap or graft loss and alter the final appearance. No consensus emerges from the scant published data on postoperative care after CCCS surgery. The objective of this study was to assess the role for temporary external fixation in stabilising the commissure and facilitating surgical wound care.

Hypothesis: Using external fixation after CCCS release facilitates postoperative wound care and decreases the complication rate.

Material and methods: Eighteen patients requiring primary CCCS surgery or revision CCCS surgery due to adhesions or web creep were included in a single-centre retrospective study. After release, an external fixator made of Kirschner pins was installed to temporarily immobilise the inter-phalangeal joints. The dressing was changed every 3 days for 3 weeks, and the external fixator was then removed. The parents and nurses completed questionnaires that used 0-10 point scales to assess ease and duration of dressing changes and perceptions and apprehensions experienced by parents and nurses, as well as pain by patients, during dressing changes.

Results: No patient experienced maceration or failure of a graft or flap. Pin site discharge was noted in 1 patient and resolved fully after pin removal. Pain intensity was estimated at 4.2/10 during the first dressing change and 1.3/10 during the last dressing change. In the parents, apprehension was 9.6/10 and 5.1/10 during the first and last dressing changes, and stress was 8.1/10 and 4.1/10, respectively. Dressing change difficulty was rated 1.1/10 at the first and 0.9/10 at the last dressing change. Dressing change duration decreased from 13 to 10minutes.

Conclusion: These encouraging results support temporary commissure stabilisation by an external fixator to decrease postoperative complication rates and facilitate dressing changes after CCCS release.

Level of evidence: IV, retrospective observational study.

Keywords: Complex syndactyly; Dressing; External fixator; Postoperative care.

MeSH terms

Bandages*
Child, Preschool
External Fixators*
Female
Fingers / abnormalities*
Fingers / surgery
Humans
Infant
Male
Postoperative Care / methods*
Radiography
Retrospective Studies
Surgical Flaps*
Surgical Wound Infection / prevention & control*
Syndactyly / diagnosis
Syndactyly / surgery*