Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada.
Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada; Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
J Plast Reconstr Aesthet Surg. 2021 Nov;74(11):2977-2992. doi: 10.1016/j.bjps.2021.03.094. Epub 2021 Apr 18.
Despite lower extremity polydactyly (LEP) representing the most common congenital foot anomaly with functional and psychosocial implications, the literature is devoid of comprehensive, synthesizing reviews. The purpose of the current review is to identify an evidence-based approach to guide clinical management and shed light on reported functional and esthetic outcomes for postaxial polydactyly.
A scoping systematic review of primary clinical studies was performed. Baseline patient characteristics, diagnostic, and surgical approaches were recorded. Main outcomes included immediate postoperative pain, infections, callouses, scar cosmesis, residual deformities, and difficulty with shoe-wear or mobility. A qualitative synthesis of outcomes was performed, and a therapeutic algorithm was developed.
Nine primary studies were identified representing 375 cases of LEP; mean age was 28.8 months (range: 20-40.6 months), and mean follow-up: 42.7 months (range: 1 month-41 years). Ray dominance and the presence of syndactyly were identified as the most important factors for surgical planning; age at surgery was insignificant. A lateral incision approach was used in 78% of cases. Postoperative callouses occurred in 22.1% of cases, infections in 2.5%, and intermittent pain in 11.9%. Significant issues with shoe-wear or mobilization and esthetic residual deformities were reported for 0.78% and 41.2% of cases, respectively. The incidence of residual valgus was 10.6%.
LEP is most commonly managed with excision of the non-dominant ray and carries excellent long-term functional outcomes, as presented herein. Numerous techniques are discussed to minimize the risk of esthetic sequalae, although the presence of residual valgus remains a concern. A therapeutic algorithm is proposed for the optimal management of LEP.
尽管下肢多趾畸形（LEP）是最常见的先天性足部畸形，具有功能和心理社会影响，但文献中缺乏全面的综合综述。本研究的目的是确定一种循证方法来指导临床管理，并阐明后轴多趾的报告功能和美容结果。
对主要临床研究进行了范围广泛的系统回顾。记录了基线患者特征、诊断和手术方法。主要结果包括术后即刻疼痛、感染、胼胝、瘢痕美容、残留畸形以及穿鞋或活动困难。对结果进行了定性综合分析，并制定了治疗算法。
确定了 9 项主要研究，共涉及 375 例 LEP 患者；平均年龄为 28.8 个月（范围：20-40.6 个月），平均随访时间为 42.7 个月（范围：1 个月至 41 年）。射线优势和并趾的存在被确定为手术规划的最重要因素；手术年龄并不重要。78%的病例采用外侧切口入路。22.1%的病例发生术后胼胝，2.5%的病例发生感染，11.9%的病例间歇性疼痛。0.78%的病例存在严重的穿鞋或活动受限问题，41.2%的病例存在美容残留畸形。残留的外翻发生率为 10.6%。
LEP 最常采用切除非优势射线的方法治疗，如本文所述，具有极好的长期功能结果。尽管存在残留的外翻仍然是一个问题，但讨论了许多技术来降低美容后遗症的风险。提出了治疗算法以优化 LEP 的管理。
