@entity4886 is a relatively uncommon @entity558 that is instantly recognizable on the basis of the pan-syndactylies involving both the hands and feet. For more than 10 years, the treatment of @entity4886 hand and foot anomalies was approached in a comprehensive manner, with attempts to maximize the final results and minimize the total number of operations. Numerous conventions were abandoned in the development of this approach, with the introduction of some new methodologies, including (1) release of all 10 fingers, and toes, in only two operations, (2) elimination of routine digital amputations, (3) abandonment of the zigzag incision in favor of straight-line release, (4) substitution of equal-length anterior and posterior flaps for the long dorsal web space lining @entity1912 , (5) leaving of small areas of exposed bone without vascularized tissue coverage, and (6) performance of @entity70269 , among older @entity1 , to improve hand function. Fifty-seven @entity1 with @entity4886 have been treated at the author's center since 1990, and 43 underwent surgical treatment of their hands and feet by a single surgeon. Treatment can be separated into two phases, early (syndactyly releases) and late (functional osteotomies). Seventeen of those 43 @entity1 were treated at the author's center from birth (type I, 11 @entity1 ; type II, two @entity1 ; type III, four @entity1 ), and 10 fingers and 10 toes were achieved for all @entity1 in two operations. No digital amputations were performed for any of the 43 @entity1 . However, four of 26 @entity1 (15 percent) not treated at the author's center from birth had undergone at least one digital amputation before coming to the center. Twenty-two of those 26 @entity1 required a two-stage syndactyly release to accomplish the separation of all 10 fingers and toes. Aside from the @entity1 who had previously undergone amputations, all other @entity1 successfully achieved 10 fingers and toes, except for one @entity1 (38 of 39 @entity1 , 97 percent). The average operative time for the first-stage syndactyly release of the hands and feet was 4 hours 11 minutes (range, 185 to 300 minutes), and that for the second stage was 3 hours 49 minutes (range, 160 to 300 minutes). Twenty-eight hands were treated with functional osteotomies, which involved permanent angulation of the fused phalanges at the proximal interphalangeal level, to create a "position of function" and provide pulp-to-pulp pinch. In addition, targeted osteotomies of the feet were performed for many of these @entity1 , to decrease @entity158 with walking. There were no major complications. Minor complications included one reexploration because of @entity548 , early in the series. There were 13 incomplete @entity15723 that required a subsequent operative release (10 spaces treated at the author's center and three treated elsewhere), of a total of 342 spaces (3 percent author incidence). There were no scar contractures or functional limitations that required release. This distinctive protocol seemed to result in improved functional outcomes, with a reduction in the total number of operative procedures.

Treatment of the hands and feet in XXXX : an evolution in management.

@entity1 :: ('9606', 'Species') :: ['children', 'patients', 'patient'] @entity558 :: ('MESH:C536528', 'Disease') :: ['condition'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity4886 :: ('MESH:D000168', 'Disease') :: ['Apert syndrome'] @entity1912 :: ('241', 'Gene') :: ['flap'] @entity15723 :: ('MESH:D013576', 'Disease') :: ['secondary syndactylies'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain'] @entity70269 :: ('MESH:C537471', 'Disease') :: ['midphalangeal osteotomies']
@entity4886 :: (MESH:D000168,Disease) :: ['Apert syndrome']
