Rajasubramanya Priyavrata, Rajan Sheeja
Department of Plastic and Reconstructive Surgery, Government Medical College, Kozhikode, Kerala, India.
J Hand Surg Asian Pac Vol. 2025 Aug;30(4):392-398. doi: 10.1142/S2424835525500584. Epub 2025 Jul 22.
Congenital syndactyly is one of the most common congenital hand anomalies (1 in 3,000 live births). The ideal surgical technique must rebuild a satisfactory web space, restore digit abduction and avoid secondary contracture. The dorsal omega flap reduces the need for skin graft, thereby reducing web creep and contracture. There is a gap in literature on patient reported outcomes regarding the dorsal omega flap. We conducted a cross-sectional study to assess the outcomes patients operated with this technique. The aim of this study is to assess quality of life using Patient Reported Outcome Measures Information Systems (PROMIS) (upper extremity parent proxy short form) and to assess scar of dorsal omega flap subjectively using Visual analogue scale (VAS) and objectively using Vancouver Scar Score (VSS) and Withey score. Fifty-one children underwent congenital syndactyly correction between 2015 and 2021 at our institute. Seventeen children (45 webs) could be contacted for outpatient visit. Thirty-seven webs had undergone the dorsal omega flap. Withey's score and VSS for objective assessment of web and VAS for subjective scar assessment by parents. Parents were also administered the PROMIS (upper extremity parent proxy short form). The data analysis was performed using SPSS software (v22). Patients who underwent surgery at least 4 years ago reported a higher median VSS (35) compared to those less than 4 years post-surgery (30). VAS and VSS showed improvement with time elapsed since surgery (ANOVA test), which was significant at < 0.05. Median PROMIS score is lower in patients who had a graft used for coverage. But this was not significant statistically. The use of graft or the lack of it did not affect median VSS. PROMIS scores improve over time. The use of graft was associated with lower PROMIS scores. Older scars were of significantly better quality than more recent scars. Level IV (Therapeutic).
先天性并指是最常见的先天性手部畸形之一（每3000例活产中有1例）。理想的手术技术必须重建一个令人满意的指蹼间隙，恢复手指外展并避免继发性挛缩。背侧ω皮瓣减少了植皮的需求，从而减少了指蹼挛缩和挛缩。关于背侧ω皮瓣的患者报告结局，文献中存在空白。我们进行了一项横断面研究，以评估接受该技术手术的患者的结局。本研究的目的是使用患者报告结局测量信息系统（PROMIS）（上肢家长代理简表）评估生活质量，并使用视觉模拟量表（VAS）主观评估背侧ω皮瓣的瘢痕，使用温哥华瘢痕评分（VSS）和威西评分进行客观评估。2015年至2021年期间，我院有51名儿童接受了先天性并指矫正手术。17名儿童（45个指蹼）可以联系进行门诊复查。37个指蹼接受了背侧ω皮瓣手术。使用威西评分和VSS进行指蹼的客观评估，使用VAS进行家长对瘢痕的主观评估。还对家长进行了PROMIS（上肢家长代理简表）评估。使用SPSS软件（v22）进行数据分析。与术后不到4年的患者相比，至少4年前接受手术的患者报告的VSS中位数更高（35）。VAS和VSS显示，自手术以来随着时间的推移有所改善（方差分析检验），在<0.05时具有显著性。接受植皮覆盖的患者的PROMIS中位数得分较低。但这在统计学上并不显著。植皮的使用与否不影响VSS中位数。PROMIS评分随时间改善。植皮的使用与较低的PROMIS评分相关。较老的瘢痕质量明显优于较新的瘢痕。IV级（治疗性）。
