RESUMEN

Introducción. La simbraquidactilia es una malformación congénita de la mano poco frecuente que se produce en el período inicial de la gestación. Abarca un amplio espectro de presentaciones clínicas que incluyen desde la presencia de dedos hipoplásicos a la ausencia total de estos. Generalmente no tiene asociación genética aunque en ocasiones se presenta junto a otras malformaciones. Paciente y método. El objetivo de este trabajo es evaluar los resultados funcionales, psicológicos y estéticos en aquellos pacientes con simbraquidactilia grado IV que recibieron una doble transferencia de dedo de pie a la mano. Para ello analizamos retrospectivamente la historia clínica de 6 pacientes, 5 niños y una niña que fueron sometidos a esta intervención en nuestra Unidad en los últimos 5 años. El tiempo de seguimiento de los pacientes una vez realizada la segunda transferencia oscila entre los 3 meses y los 5 años. Resultados. Se realizó siempre transferencia de segundo dedo de pie en primer lugar al primer metacarpiano y en la segunda intervención a la posición del cuarto dedo. La edad media cuando se hizo la primera transferencia fue de 19 meses y en la segunda intervención de 30 meses. No se produjo ninguna complicación postoperatoria inmediata ni la pérdida de ningún injerto. Dos pacientes precisaron tenólisis y transfererencia tendinosa posterior para mejorar la posición y funcionalidad de los injertos. Todos los niños iniciaron un programa de rehabilitación precoz. En los seis niños se constató una importante mejoría en la estética de la mano así como una buena funcionalidad, con capacidad para realizar pinza tanto de objetos gruesos como de pequeños. La aceptación psicológica fue buena tanto en los niños como en los padres. Ninguno de los pacientes presentó alteración en la marcha. Conclusiones. La doble transferencia de dedo de pie a la mano es un tratamiento eficaz en niños con simbraquidactilia con ausencia de pulgar. La rehabilitación es imprescindible para lograr la completa funcionalidad. Este tratamiento mejora la integración del niño en el medio familiar, escolar y social (AU)

Introducction. Symbrachydactyly is fairly frequent congenital malformation that appears during first weeks of pregnancy. The range of clinical presentations goes from hypoplastic fingers to true agenesis. Although it usually appears in a random fashion, sometimes it is associated to other systemic malformations. Patients and methods. The aim of this study is to check the functional, cosmetic and psychological results of those patients affected of grade IV symbrachydactyly treated using a double second toe transfer. The method employed is a retrospective study of the clinical records from 6 patients (5 males and 1 female) operated in our Department during the last five years. The follow up period was from 3 months to five years. Results. Transfer from the second toe to the first ray was performed during the first surgical period, while transfer to the fourth ray was done in a second procedure. The mean age for the first operation was 19 months, and 30 months for the second one. There were no flap failure or major surgical complications. Tenolysis and tenoplasty was done in two patients to improve flap function and position. Motion rehabilitation was installed during the postoperative period. Functional, opposing pinch, and cosmetic results were satisfactory. Parents ”and patients” psychological acceptance was also good. No walk disturbance was observed. Conclusions. Double second toe to hand transfer is a good option for the symbrachydactyly treatment in cases of thumb agenesis. Rehabilitation is the key clue for functional recovery. Surgery improves social and family relationships (AU)

Asunto(s)

RESUMEN

INTRODUCTION: Symbrachydactyly is fairly frequent congenital malformation that appears during first weeks of pregnancy. The range of clinical presentations goes from hypoplastic fingers to true agenesis. Although it usually appears in a random fashion, sometimes it is associated to other systemic malformations. PATIENTS AND METHODS: The aim of this study is to check the functional, cosmetic and psychological results of those patients affected of grade IV symbrachydactyly treated using a double second toe transfer. The method employed is a retrospective study of the clinical records from 6 patients (5 males and 1 female) operated in our Department during the last five years. The follow up period was from 3 months to five years. RESULTS: Transfer from the second toe to the first ray was performed during the first surgical period, while transfer to the fourth ray was done in a second procedure. The mean age for the first operation was 19 months, and 30 months for the second one. There were no flap failure or major surgical complications. Tenolysis and tenoplasty was done in two patients to improve flap function and position. Motion rehabilitation was installed during the postoperative period. Functional, opposing pinch, and cosmetic results were satisfactory. Parents "and patients" psychological acceptance was also good. No walk disturbance was observed. CONCLUSIONS: Double second toe to hand transfer is a good option for the symbrachydactyly treatment in cases of thumb agenesis. Rehabilitation is the key clue for functional recovery. Surgery improves social and family relationships.

Asunto(s)

RESUMEN

Sindactilia compleja es aquélla en la que los dedos están unidos por hueso, además de piel, si bien hay casos en los que sin haber fusión ósea la aparición de interconexiones nerviosas, vasculares o tendinosas hace que se los denomine igualmente de este modo. Además, si los huesos unidos son anómalos, lo cual es frecuente (falanges delta, braquidactilia, etc.), la sindactilia se denomina 'complicada'. Presentamos nuestra técnica y resultados en el tratamiento de 35 pacientes con sindactilia congénita compleja o complicada, así como 58 niños con sindactilia adquirida en el contexto de quemaduras y epidermolisis bullosa (AU)

Asunto(s)

RESUMEN

Complex syndactyly is generally defined as abnormal digital interconnection by bone, but sometimes simple syndactyly with complicated cutaneous, musculotendinous or neurovascular interconnections should be considered complex as well. Additionally, complex syndactyly involving anomalous bones (delta phalanx, brachiphalangism...) falls in different category called "complicated". 35 patients with complex or complicated congenital syndactyly are studied and 58 children with cutaneous syndactyly due to burns and epidermolysis bullosa are analyzed as well.

Asunto(s)

RESUMEN

A case of venous graft repair to recover blood flow of a newborn's upper extremity, is described. Even though this complication remains uncommon, we emphasize on to avoid brachial artery for vascular monitorization and to perform microsurgical revision as elective procedure if conservative therapy is unsuccessful.

Asunto(s)

RESUMEN

The association of soft tissue and bone sarcoidosis in the hand and wrist is rare. Two cases of sarcoidosis, 1 with involvement of the distal radius and both flexor and extensor tendons in the wrist and another with tenosynovitis of 2 fingers associated with phalangeal osteolysis, are reported. Both patients were surgically treated by tenosynovectomy. The importance of the systemic corticosteroid therapy is emphasized.

Asunto(s)

RESUMEN

In order to determine the efficacy of the carpal compression test (CCT) in the diagnosis of the carpal tunnel syndrome (CTS), we conducted a prospective study on 200 consecutive hands diagnosed as having CTS. A control group of 100 healthy volunteers with no symptoms of CTS were also assessed. The results of the CCT in the patients and controls were compared with those obtained with Phalen's and Tinel's tests. CCT achieved a sensitivity of 87%, and a specificity of 95%. It is a simple, fast and very reliable provocative test, and should be routinely used in the diagnosis of CTS. This test is also an appropriate manoeuvre in wrists with limited range of motion or pain that cannot be assessed with Phalen's wrist flexion test.

Asunto(s)