Haanen Anne Sophie, Natroshvili Tina, Kemler Marius A
Martini Ziekenhuis, Groningen. Afd. Chirurgie.
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Ned Tijdschr Geneeskd. 2024 Sep 18;168:D7751.
This clinical lesson addresses the treatment options for polydactyly, emphasizing the lack of consensus in the Netherlands regarding the timing and method of intervention. The study aims to provide evidence-based recommendations for the management of post-axial polydactyly type B. Two cases are presented, each illustrating different approaches to surgical intervention for post-axial polydactyly type B in a 1-year-old boy (Patient A) and a newborn girl (Patient B). Patient A undergoes surgical removal of an extra digit under general anesthesia after waiting for a year, while Patient B undergoes prompt surgical removal under local anesthesia. Both procedures are successful with no complications, demonstrating positive outcomes for early surgical intervention under local anesthesia. The study advocates for revising outdated national guidelines, recommending surgical removal under local anesthesia within the first three months after birth for post-axial polydactyly type B. Delaying intervention increases stress, risks, and costs without apparent benefits. This clinical lesson calls for optimizing care for children with post-axial polydactyly type B through guideline updates.
本临床案例探讨了多指畸形的治疗方案,强调了荷兰在干预时机和方法上缺乏共识。该研究旨在为B型轴后多指畸形的管理提供循证建议。文中介绍了两个案例,分别说明了对一名1岁男孩(患者A)和一名新生儿女孩(患者B)进行B型轴后多指畸形手术干预的不同方法。患者A在等待一年后,在全身麻醉下接受了多余手指的手术切除,而患者B在局部麻醉下迅速接受了手术切除。两种手术均成功且无并发症,表明局部麻醉下早期手术干预有积极效果。该研究主张修订过时的国家指南,建议对B型轴后多指畸形在出生后的头三个月内进行局部麻醉下的手术切除。延迟干预会增加压力、风险和成本,且无明显益处。本临床案例呼吁通过更新指南来优化对B型轴后多指畸形儿童的护理。