20240726 Syndactyly - Dr YY

A 1 year old girl presented to the clinic with bilateral hand and feet deformities. According to mother, mother noticed these deformities since birth. Otherwise, child has no other medical conditions, developmental milestones are appropriate to her age. On further questioning, there is no family members or relatives with similar condition as the child.

What is the most likely condition does this patient have?

• A. Apert Syndrome

• B. Carpenter syndrome

• C. Constriction ring syndrome

• D. Poland syndrome

• E. Simple syndactyly

1 year 5 months months old boy brought to clinic by parents who noticed right hand deformity since birth. The following are clinical photos and radiographs of the child. How would you classify this condition?

• A. Simple incomplete syndactyly of right index, middle and right fingers

• B. Simple complete syndactyly of index, middle and right fingers

• C. Complicated syndactyly of right index, middle and ring fingers

• D. Complex syndactyly of right index, middle and ring fingers

• E. Simple complicated syndactyly of right index, middle and ring fingers

A 1 year 6 months old boy with underlying Apert Syndrome, generalized ventriculomegaly with epilepsy, laryngomalacia and upper airway obstruction secondary to craniofacial anomaly was brought to the clinic by his mother complaining of deformity of both hands since birth. The child has not started to walk yet and is only able to grasp objects but unable to perform pincer grip. What is the best management option for this child?

• A. Observe only for now as the child has other more serious medical conditions

• B. Explore mother’s concerns and expectations, assess child’s fitness for surgery and counsel mother for syndactyly release of all the fingers in the same setting

• C. Explore mother’s concerns and expectations, assess child’s fitness for surgery and counsel mother for syndactyly release of right middle and ring fingers and deepening of right first web space

• D. Explore mother’s concerns and expectations, assess child’s fitness for surgery and counsel mother for syndactyly release of bilateral middle and ring fingers and deepening of bilateral first web spaces

• E. Counsel mother against surgery because surgery for syndactyly release in this child will do more harm and will not improve further the hand function of the child

A 1 year old boy with isolated simple complete syndactyly of his left middle and ring fingers is planned for a syndactyly release. Which of the following is the most appropriate surgical techniques of syndactyly release for this child?

• A. Reconstruct the web space with a proximally based rectangular flap raised from the dorsum of the syndactyly, separate the digits with matching palmar and dorsal zigzag flaps, cover skin defects with full thickness skin grafts and finally reconstruct the paronychial fold

• B. Separate the digits and web space with simple longitudinal incision, cover skin defect at the web space with full thickness skin grafts and finally reconstruct the paronychial fold

• C. Reconstruct the web space with a proximally based rectangular flap raised from the palmar of the syndactyly, separate digits with a simple longitudinal incision, cover skin defects with split-thickness skin grafts and finally reconstruct the paronychial fold

• D. Reconstruct the web space with a standard four-flap “Z”-plasty, separate digits with a simple longitudinal incision, defat the digits to close the wound primarily to avoid using grafts and finally reconstruct the paronychial fold

• E. Reconstruct the web space with a double-opposing “Z”-plasty, separate the digits with matching palmar and dorsal zigzag flaps, allow skin defects to heal by secondary intention and finally reconstruct the paronychial fold

A 6 months old girl presented to clinic with the following deformity of the right hand. After discussion with the parents, child was planned for a syndactyly release of the affected fingers with full thickness skin graft from the groin the following week. What is the most common late complication of this surgery that should be anticipated?

• A. Web creep

• B. Infection

• C. Fixed flexion deformity

• D. Graft loss

• E. Vascular compromise