Oh Sang Ho, Woo Sang Hyun
W Institute for Congenital Deformity of the Extremities, W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, South Korea.
Plast Reconstr Surg Glob Open. 2021 Nov 29;9(11):e3946. doi: 10.1097/GOX.0000000000003946. eCollection 2021 Nov.
Keloid formation after syndactyly division is a stressful situation for patients. In our experience, digital enlargement may be involved in keloid formation following syndactyly divisions. Therefore, we aimed to identify predictive factors and reference values for keloid formation.
In this retrospective study, 11 keloid patients (seven children, four adults) and 11 nonkeloid patients after syndactyly division (control group) with the same sex, age, webspace division site, and operation were enrolled between 2008 and 2020. Using preoperative x-ray images, we compared bony width, length, area, and protruding index relative to the great toe between keloid and control groups. Additionally, reference values for keloid formation were obtained using receiver operating characteristic curves. Statistical analysis was performed using Spearman's correlation test.
When compared with the same digit in the normal foot, distal phalanx (P3) bony base width, area, and protruding index on keloid foot were significantly different between keloid group and control group. The reference values for keloid formation after syndactyly release were 1.34 for the P3 area ratio and 1.61 for the P3 triangular area ratio (using the horizontal length of the P3 base and P3 vertical length). The reliability of reference values for the P3 area ratio and P3 triangular area ratio was excellent for all patients.
If digital enlargement in distal phalanx is present when compared with adjacent toe in patients who had undergone primary foot syndactyly divisions, risk of keloid development should be communicated preoperatively, and preventive strategies for keloid development and close observations are required.
并指分离术后瘢痕疙瘩形成对患者来说是一种压力情况。根据我们的经验，手指增粗可能与并指分离术后瘢痕疙瘩形成有关。因此，我们旨在确定瘢痕疙瘩形成的预测因素和参考值。
在这项回顾性研究中，纳入了2008年至2020年间11例瘢痕疙瘩患者（7名儿童，4名成人）和11例并指分离术后无瘢痕疙瘩患者（对照组），两组患者性别、年龄、蹼间隙分离部位和手术相同。使用术前X线图像，我们比较了瘢痕疙瘩组和对照组相对于大脚趾的骨宽度、长度、面积和突出指数。此外，使用受试者工作特征曲线获得瘢痕疙瘩形成的参考值。采用Spearman相关性检验进行统计分析。
与正常足部同一手指相比，瘢痕疙瘩组和对照组瘢痕疙瘩足部的远节指骨（P3）骨基底部宽度、面积和突出指数存在显著差异。并指松解术后瘢痕疙瘩形成的参考值为P3面积比1.34，P3三角形面积比1.61（使用P3基部的水平长度和P3垂直长度）。P3面积比和P3三角形面积比参考值对所有患者的可靠性都很好。
对于接受过原发性足部并指分离术的患者，如果与相邻脚趾相比远节指骨存在手指增粗情况，应在术前告知瘢痕疙瘩形成的风险，并且需要采取预防瘢痕疙瘩形成的策略并进行密切观察。
