Department of Plastic and Reconstructive Surgery, Nagasaki University Hospital, Nagasaki, Japan; Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Plastic and Reconstructive Surgery, Nagasaki University Hospital, Nagasaki, Japan; Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
J Foot Ankle Surg. 2022 May-Jun;61(3):621-626. doi: 10.1053/j.jfas.2021.10.025. Epub 2021 Oct 28.
The treatment of postaxial polydactyly requires excision of the medial fifth or lateral sixth toe, and separation of the adjacent fourth/fifth toes if the adjacent toes exhibit skin syndactyly. Morphological changes in the retained toes and reoperation are common problems after such surgery. This study examined the effects of preoperative classifications and selecting the medial fifth or lateral sixth toe for excision on the postoperative outcomes of surgery for postaxial polydactyly. From April 2006 to March 2019, surgery for postaxial polydactyly was performed on 55 feet in 49 patients. The patients' mean age at surgery was 28.8 months. Postoperative esthetic and bone alignment scores, the reoperation rate, and postoperative dysfunction were examined. The postoperative esthetic and bone alignment evaluations were performed by examining postoperative photograph and X-ray images using original scoring systems. The surgical procedure was chosen by the surgeon-in-charge during a preoperative conference after considering the toe growth and bone alignment. In the postoperative esthetic evaluation, excising the lateral sixth toe produced significantly better outcomes than excising the medial fifth toe. The morphological classification also indicated that excising the lateral sixth toe produced better outcomes, as it resulted in the bifurcated toes being clearly independent. Interestingly, the postoperative X-ray-based bone alignment score was not correlated with the esthetic score. The reoperation rate tended to be high after medial fifth toe excision. There were no postoperative functional complications. Lateral sixth toe excision for postaxial polydactyly of the foot produces good postoperative esthetic outcomes.
治疗轴后多指畸形需要切除内侧第五或外侧第六趾，如果相邻的第四/五趾存在皮肤并趾，还需要分离相邻的脚趾。保留的脚趾的形态变化和再次手术是此类手术后常见的问题。本研究旨在探讨术前分类和选择切除内侧第五或外侧第六趾对轴后多指畸形手术后结果的影响。2006 年 4 月至 2019 年 3 月，49 例患者的 55 足接受了轴后多指畸形手术。患者的平均手术年龄为 28.8 个月。检查了术后美观和骨骼对线评分、再次手术率和术后功能障碍。术后外观和骨骼对线评估通过使用原始评分系统检查术后照片和 X 射线图像进行。手术程序由主治医生在术前会议上根据考虑到的脚趾生长和骨骼对线情况选择。在术后外观评估中，切除外侧第六趾的效果明显优于切除内侧第五趾。形态学分类也表明，切除外侧第六趾的效果更好，因为它使分叉的脚趾明显独立。有趣的是，术后基于 X 射线的骨骼对线评分与美学评分无关。内侧第五趾切除后再次手术的几率较高。无术后功能并发症。对于足部的轴后多指畸形，切除外侧第六趾可获得良好的术后美观效果。
