Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Treatment of Apert Hand Syndrome: Strategies for Achieving a Five-Digit Hand

Raposo-Amaral, Cassio Eduardo, M.D., Ph.D.; Denadai, Rafael, M.D.; Furlan, Pedro, M.D.; Raposo-Amaral, Cesar Augusto, M.D.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 972-982
doi: 10.1097/PRS.0000000000004815
Hand/Peripheral Nerve: Original Articles
Buy
SDC

Background: Apert hand reconstruction requires complex surgical planning. The purpose of this study was to describe the authors’ 8-year surgical experience with Apert syndrome hand reconstruction, and provide specific surgical strategies for achieving a five-digit hand in Upton type I and II hands.

Methods: A retrospective analysis of consecutive Apert syndrome patients who underwent web-space releases between 2007 and 2015 was performed. Demographic, surgical, and outcome data were verified through medical records, clinical photographs, radiographic images, and patient interviews.

Results: A total of 41 Apert syndrome patients [23 boys (56.1 percent) and 18 girls (43.9 percent)] have been treated at our hospital since 2007. A five-digit hand was achieved in all patients (100 percent) with Upton type I and II hands, and in eight patients (72.7 percent) with Upton type III hands. A four-digit hand was obtained in three of 11 patients (27.3 percent) with Upton type III hands. Four of 20 patients (25 percent) with Upton type I hands, three of 10 patients (30 percent) with Upton type II hands, and six of 11 patients (54.5 percent) with Upton type III hands required subsequent revision for aesthetic reasons.

Conclusions: Upton type III hands have demonstrated higher revision rates than type I and II hands, regardless of whether a four- or five-digit hand is obtained. Treatment strategies for Apert syndrome hands based on hand type are offered to guide four–web-space release in all patients with Upton type I and II hands.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Campinas, São Paulo, Brazil

From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital.

Received for publication August 27, 2017; accepted April 10, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

Cassio Eduardo Raposo-Amaral, M.D., Ph.D., Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil, cassioraposo@hotmail.com

Copyright © 2018 by the American Society of Plastic Surgeons