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A Straightforward Approach to Apert Pedal Syndactyly Release
Christina R Vargas, MD
Anand R Kumar, MD, FACS, FAAP
University Hospitals Cleveland Medical Center
2021-01-30
Presenter: Christina Vargas, MD
Affidavit:
100% of this project represents the original work of the submitting resident.
Director Name: Edward Davidson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Apert syndrome, acrocephalosyndactyly, includes syndactylies of the hands and feet along with significant facial and calvarial anomalies. Various surgical approaches to Apert toe syndactyly release have been extrapolated from management of the hand, each with advantages and disadvantages in this patient population. No consensus for an optimal method of pedal syndactyly release has been recognized in the surgical literature. A simple technique for staged straight-line releases with dorsal webspace flaps is presented here.
Methods
The senior author's technique for two-stage surgical release of Apert pansyndactyly of the toes is described in an 8-year-old patient with painful ambulation (Figure 1). The first and third webspaces are released in stage 1 followed by second and fourth webspaces in the interval procedure. Straight-line release is performed with preservation of digital neurovascular bundles and dorsal webspace flap inset followed by midlateral full-thickness skin grafts (Figure 2). Absorbable sutures and postoperative splinting further optimize surgical outcome.
Results
Excellent functional and aesthetic results are noted with staged straight-line release, dorsal webspace lining flap inset, and midlateral full thickness skin grafts (Figure 3). Donor site morbidity is minimal and patient satisfaction is high. Postoperative splints are removed at postoperative day 10 and occupational therapy referral is made if indicated for fabrication of orthotic aids to further facilitate ambulation.
Conclusions
The authors present a technique for reliable, reproducible, and efficient two-stage release of Apert pedal syndactyly intended to maximize functional and aesthetic outcome while minimizing surgical risk and number of procedures as a component of multidisciplinary management.
