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Congenital syndactyly and polydactyly malformations

  Congenital polydactyly and toe deformations are the most common congenital diseases in children, and some are accompanied by cardiovascular or urinary system malformations. Polydactyly is more common on the outer side of the thumb and the inner side of the small finger, with other fingers less involved. Among them, the incidence of polydactyly is the highest, which has a significant impact on the appearance and function of the hand, and its diagnosis and treatment are the focus of pediatric orthopedic doctors.

  Congenital syndactyly, also known as webbed fingers, is most common in the third and fourth fingers, with the thumb rarely involved. The most common cases involve only soft tissue connection between adjacent fingers, occasionally with bone and joint connection. It is more common on both sides and sometimes accompanied by toe deformities, as well as other limb abnormalities.

 

Table of Contents

1. What are the causes of congenital syndactyly and polydactyly malformations?
2. What complications can congenital syndactyly and polydactyly malformations easily lead to?
3. What are the typical symptoms of congenital syndactyly and polydactyly malformations?
4. How should congenital syndactyly and polydactyly malformations be prevented?
5. What laboratory tests are needed for congenital syndactyly and polydactyly malformations?
6. Dietary preferences and taboos for patients with congenital syndactyly and polydactyly malformations
7. Conventional methods of Western medicine for the treatment of congenital syndactyly and polydactyly malformations

1. What are the causes of congenital syndactyly and polydactyly malformations?

  During the development process, the fingers begin to be fused together and gradually separate to form a thumb and four fingers. If an abnormality occurs during this process, leading to incomplete separation or no separation of the fingers, partial or complete syndactyly may occur. The exact cause of syndactyly is not yet clear, with a few cases having a genetic component and most cases having an unknown cause.

2. What complications are easily caused by congenital syndactyly and polydactyly malformations

  Congenital syndactyly and polydactyly malformations are divided into preaxial type, postaxial type, and central type. In congenital polydactyly and syndactyly, the ulnar polydactyly may be accompanied by syndactyly, three-segment phalanx thumb, spinal malformation, nail developmental abnormalities, and so on.

 

3. What are the typical symptoms of congenital syndactyly and polydactyly malformations

  Congenital syndactyly and polydactyly malformations are divided into preaxial type, postaxial type, and central type, and their specific causes of onset are described as follows.

  One, preaxial type polydactyly

  1, type I and II symmetrical polydactyly:The central part of the bifurcation, including the nail of the thumb, the phalanx, and the soft tissue, should be equally wedge excised, and the remaining parts should be sutured together; for asymmetrical polydactyly, the malformed fingers that are deviated from the normal fingers and have small development should be excised, but attention should be paid to the reconstruction of the lateral nail groove of the nail.

  2, type III and IV symmetrical polydactyly:The treatment methods for type I and II symmetrical polydactyly can be used, and the radial or ulnar polydactyly can be excised, positioned, and fixed with Kirschner wires. However, attention should be paid to transplanting the abductor pollicis brevis muscle when excising radial polydactyly, and the adductor pollicis muscle when excising ulnar polydactyly. For congenital malformations of asymmetrical polydactyly, after excising the polydactyly, wedge osteotomy of the metacarpal head should be performed, and attention should also be paid to the repair of the collateral ligaments and the transplantation of the insertions of the thenar muscles.

  3, types V and VI:Generally, the worst-developed polydactyly (such as radial polydactyly, or ulnar polydactyly) is excised, and if the web is narrow, a 'Z' shaped lengthening operation can be performed. If the web is expanded, a tightening operation can be performed.

  4, type VII polydactyly:The most common malformation is the bifurcation of the thumb, and the malformation can be corrected by wedge osteotomy or Kirschner wire internal fixation after the removal of the polydactyly.

  Two, postaxial type polydactyly

  For type I polydactyly, complete excision and simple suture are sufficient. For type II and III polydactyly, it is necessary to determine and protect the very small abductor tendons and ulnar collateral ligaments outside the bifurcation periosteum, remove the extra fingers, trim the extra bone at the bifurcation, and reconstruct the collateral ligaments and abductor tendons.

  Three, central type polydactyly

  For simple central polydactyly, the worst-developed finger should be removed, and the principles of repair and reconstruction are the same as those for the thumb and little finger. Malformations involving distal phalanx fusion should be operated on within 1 year to ensure normal hand function development. Other malformations are best operated on around the age of 5. If malformations occur due to不平衡 development, surgery should be performed earlier, and non-functional fingers can be operated on later.

 

4. How to prevent congenital syndactyly and polydactyly malformations

  Congenital polydactyly patients usually have extra fingers growing next to the thumb, and the thumb is the most important finger, so it is very important to preserve and reconstruct the thumb function during the surgery to remove the extra finger. The extra finger is mostly non-functional or malformed, and it should be removed to avoid affecting the normal function of the hand, and it is also very helpful in improving appearance. Some patients may find that the preserved thumb is crooked after the removal of the polydactyly, which is usually caused by ligament malformation or an extra piece of malformed bone, and these are all malformations that should be corrected early, otherwise it will be difficult to treat after the malformation becomes fixed.

5. What kind of laboratory tests need to be done for congenital syndactyly and polydactyly deformity

  The diagnosis of congenital syndactyly and polydactyly deformity mainly relies on clinical manifestations. Congenital syndactyly and polydactyly deformity is divided into preaxial polydactyly, postaxial polydactyly, and central polydactyly. X-ray examination may be necessary if required to understand the bone and joint conditions of polydactyly.

6. Dietary preferences and taboos for patients with congenital syndactyly and polydactyly deformity

  Patients with congenital syndactyly and polydactyly deformity should eat foods rich in sulfur and vitamins after surgery and avoid taking iron or vitamin supplements containing iron. The specific dietary precautions are described as follows.

  One: Foods to eat after surgery for congenital syndactyly and polydactyly deformity

  1. Eat more foods rich in sulfur, such as asparagus, eggs, garlic, and onions. Because the repair and reconstruction of bones, cartilage, and connective tissues all require sulfur as a raw material, and sulfur also helps in the absorption of calcium.

  2. Eating fresh pineapples regularly can reduce the risk of infection in the affected area.

  3. Ensure that you eat some vitamin-rich foods every day, such as flaxseed, rice bran, and oat bran.

  Two: Foods to avoid after surgery for congenital syndactyly and polydactyly deformity

  Avoid taking iron or vitamin supplements containing iron. Because iron is related to pain, swelling, and joint injury. The alkaloids in Solanaceae vegetables such as tomatoes, potatoes, eggplants, and peppers, as well as those in tobacco, can exacerbate symptoms of arthritis.

7. The conventional method of Western medicine for the treatment of congenital syndactyly and polydactyly deformity

  The main treatment method for congenital syndactyly and polydactyly deformity is surgery, and the specific treatment methods are described as follows.

  One: The best time for surgery for congenital polydactyly deformity is after the age of 1. For a few cases that require a longer period of observation of hand function to ensure the preservation of the correct fingers and the removal of the accessory fingers, the interdigital soft tissue can be incised, and the skin can be extended in a Z-shaped manner or a full-thickness skin graft can be performed. Polydactyly is a common deformity, often coexisting with deformities such as brachydactyly and syndactyly, and is more common in the thumb and little finger.

  Two: The main treatment method for congenital syndactyly deformity is surgery, which involves separating the two fingers that are fused together. After the fingers are separated, there is often not enough skin to repair the wound left after the separation, so skin grafting is required. At the same time, the design of the surgery is very important; improper design can not only increase the area of skin grafting but also affect the appearance and even the function of the hand.

  Three: Precautions for the surgery of congenital polydactyly deformity

  1. Within the first 24 hours after surgery, due to reasons such as anesthesia and the surgery itself, the child may have some crying and fussing; however, generally, after the initial 24 hours, as the pain from the wound subsides or disappears, the child will completely return to normal. To prevent infection, it is common to administer antibiotics intravenously for 3 days after surgery for anti-inflammatory treatment. If the intravenous catheter is accidentally dislodged after surgery, it is completely acceptable to no longer administer intravenous fluids and instead use oral antibiotic syrup for anti-inflammatory purposes.

  2. Generally, you can be discharged and go home 3 days after the surgery.

  3. Since the hand is wrapped with a cast bandage, there is no need to change the dressing before removing the incision sutures.

  4. The incision sutures are usually removed about 14 days after surgery, and the removal of the sutures generally needs to be done under general anesthesia (but without tracheal intubation), so it is necessary to make an appointment with the doctor and be on time at the ward at 8 o'clock in the morning on the day of removal, and the child should be fasting and drinking water after 2 o'clock at night the day before. After the sutures are removed, the child will be observed in the recovery room for a while, and can go home after full recovery.

  5. For simple duplication deformities, once the surgery is done, the treatment can be terminated; but for more complex duplication deformities, in the long term after surgery, there may be conditions such as osteophyte formation on the radial side of the thumb, bony spur formation, thumb deviation deformity, incision scar hyperplasia or contraction, and sometimes for these secondary deformities, further surgery may be needed for repair.

  IV. The Problem of General Anesthesia for Polydactyly Surgery

  For children with polydactyly, surgery must be performed under general anesthesia, which is an unavoidable matter. Many parents are worried about general anesthesia, mainly worried about whether general anesthesia will affect the child's intelligence. As a kind of anesthesia technology, general anesthesia of course has certain risks, such as aspiration, tongue drop, laryngospasm, and so on before and after surgery and during the surgery process. However, these situations can be avoided with the continuous improvement and improvement of anesthesia technology; especially during the surgery process, the anesthesiologist will closely monitor the child to ensure that there will be no hypoxia. Therefore, at present, general anesthesia surgery is very safe, and there is no need to miss the best treatment opportunity due to the worry that anesthesia will affect the child's intelligence.

  V. The Problem of Scars After Surgery

  Some careful parents may even worry about the problem of incision scars after surgery. Firstly, hand scars generally do not easily become hypertrophic scars; secondly, at present, surgeons generally choose very fine nylon threads or absorbable sutures for detailed suturing. Therefore, the scars after surgery are generally not very obvious, and as the child grows older, the scars will gradually become less obvious.

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