A Surgical Lifetime With The Apert Hand
joseph Upton, MD, Amir Taghinia, MD, Brian Labow, MD, Barkat Ali, MD.
Childrens Hospital Boston, Jamaica Plain, MA, USA.
Background: The goal of this study is to analyze the lifetime experience of one surgeon and to identify how to unlock the potential functional of these deformed limbs.Methods: This is a prospective collective experience of 171 Apert patients (342 hands) evaluated and or treated from 1977 through 2019. Hands were classified as: Type I: 68 patients (40%), Type II (35%), and Type III (25%). Data included office and hospital records, pre and post-operative pictures, radiographs and plaster molds. Functional data on selected (n=22) patients included ROM, strength (key pinch, tripod pinch, grip) measurements, DASH scores, Jebson Hand Function tests, Short-Form Health Survey Physical Health and Mental Health. Emphasis in the study was placed upon the changing trends and advances in surgical treatment.Results: Those with Type I and II hands averaged 8 to 10 operations by adolescence for digital separation, thumb realignment and lengthening, pulp and nail fold construction, contour correction, synostosis excision, and revisions. Multiple individual procedures are done at every operation; for example, an initial syndactyly release included multiple web spaces, ostectomies, pulp flaps, and local soft tissue coverage of bone. The changing trends over the four decades of treatment are summarized in Table 1.Conclusions: Correction of these hands is not a nihilistic surgical endeavor. It is now possible to accurately classify these hands, outline the algorithm for treatment over the first two decades of life, and give the parents a realistic expectation of probable functional and aesthetic results. These patients become your patients for life.
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