Raposo-Amaral Cassio Eduardo, Denadai Rafael, Furlan Pedro, Raposo-Amaral Cesar Augusto
From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital.
Plast Reconstr Surg. 2018 Oct;142(4):972-982. doi: 10.1097/PRS.0000000000004815.
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.
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.
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.
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.
Apert 手部重建需要复杂的手术规划。本研究的目的是描述作者 8 年的 Apert 综合征手部重建手术经验，并提供在 Upton I 型和 II 型手部实现五指手的具体手术策略。
对 2007 年至 2015 年期间连续接受蹼间隙松解术的 Apert 综合征患者进行回顾性分析。通过病历、临床照片、影像学图像和患者访谈核实人口统计学、手术和结果数据。
自 2007 年以来，我院共治疗了 41 例 Apert 综合征患者[23 例男孩（56.1%）和 18 例女孩（43.9%）]。所有 Upton I 型和 II 型手部的患者（100%）以及 8 例 Upton III 型手部的患者（72.7%）实现了五指手。11 例 Upton III 型手部患者中有 3 例（27.3%）获得了四指手。20 例 Upton I 型手部患者中有 4 例（25%）、10 例 Upton II 型手部患者中有 3 例（30%）以及 11 例 Upton III 型手部患者中有 6 例（54.5%）因美学原因需要后续修复。
无论获得的是四指手还是五指手，Upton III 型手部的修复率均高于 I 型和 II 型手部。提供基于手型的 Apert 综合征手部治疗策略，以指导所有 Upton I 型和 II 型手部患者的四蹼间隙松解术。
临床问题/证据级别：治疗性，IV 级。
