Muzaffar Arshad R, Rafols Francisco, Masson James, Ezaki Marybeth, Carter Peter R
Hand Service, The Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA.
J Hand Surg Am. 2004 Mar;29(2):201-8. doi: 10.1016/j.jhsa.2003.10.017.
The purpose of this study is 3-fold: to review our cases of keloid formation after syndactyly release, to report a clinical association between primary enlargement of the digits and risk of keloid formation, and to report treatment using low-dose, short-term methotrexate as an adjunct to revision surgery.
A retrospective review of patients identified with keloid formation after syndactyly reconstruction showed associated enlargement of the involved digits. A search of medical records for cases in which both syndactyly and digital enlargement occurred was carried out. Charts and images, where available, were reviewed for information about age, gender, involved site, associated conditions, and treatment.
Eight cases of keloids occurred in 1004 surgical procedures in 681 patients carried out during the 20-year period reviewed. Seven patients were white and 1 was Hispanic. Seven of the 8 had associated primary digital enlargement. Two patients who had enlarged syndactylized digits did not develop keloids after surgery. There was no family history in any case. Standard treatment (pressure, topical or intralesional corticosteroids, and re-excision) was unsuccessful in resolving the keloids. Two children treated with adjunctive methotrexate had successful treatment of their keloids and near-normal healing. Length of follow-up time after the last treatment ranged from 6 months to 11 years (average, 5.5 years).
Primary digital enlargement is highly predictive of risk of keloid formation after syndactyly reconstruction. Very-low-dose, short-term methotrexate was successful as an adjunct to surgical treatment in 2 cases.
本研究有三个目的：回顾我们在并指松解术后瘢痕疙瘩形成的病例，报告手指原发性增大与瘢痕疙瘩形成风险之间的临床关联，并报告使用低剂量、短期甲氨蝶呤作为翻修手术辅助治疗的情况。
对并指重建术后确诊为瘢痕疙瘩形成的患者进行回顾性研究，发现受累手指有相关增大。检索同时发生并指和手指增大的病例的医疗记录。如有可用的图表和图像，则对其进行审查，以获取有关年龄、性别、受累部位、相关疾病和治疗的信息。
在回顾的20年期间，681例患者的1004例手术中有8例出现瘢痕疙瘩。7例患者为白人，1例为西班牙裔。8例中有7例有相关的原发性手指增大。2例并指增大的患者术后未形成瘢痕疙瘩。所有病例均无家族史。标准治疗（压迫、外用或病灶内注射皮质类固醇以及再次切除）未能成功消除瘢痕疙瘩。2例接受甲氨蝶呤辅助治疗的儿童瘢痕疙瘩得到成功治疗，愈合接近正常。最后一次治疗后的随访时间为6个月至11年（平均5.5年）。
手指原发性增大高度预示并指重建术后瘢痕疙瘩形成的风险。极低剂量、短期甲氨蝶呤作为手术治疗的辅助手段在2例中取得成功。
