Corpus
Pmc
Racine
Corpus
Checkpoint
Pmc
Racine
Pmc
Exploration
Accueil
Racine
Racine

Serveur d'exploration sur le lymphœdème

Attention, ce site est en cours de développement !
Attention, site généré par des moyens informatiques à partir de corpus bruts.
Les informations ne sont donc pas validées.

Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases

Identifieur interne : 000D59 ( Pmc/Corpus ); précédent : 000D58; suivant : 000D60

Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases

Auteurs : Francisco Javier Downey-Carmona ; Araceli Lagares ; David Farrington-Rueda ; José Lirola-Criado

Source :

RBID : PMC:4549351

Abstract

Purpose

We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children.

Introduction

Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel–Trenaunay–Weber syndrome and Proteus syndrome.

The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved.

Methods

We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure.

Results

We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively.

Conclusions

We believe that island-nail transfer in children obtains excellent results.


Url:
DOI: 10.1007/s11832-015-0670-z
PubMed: 26238609
PubMed Central: 4549351

Links to Exploration step

PMC:4549351

Le document en format XML

<record>
<TEI>
<teiHeader>
<fileDesc>
<titleStmt>
<title xml:lang="en">Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases</title>
<author>
<name sortKey="Downey Carmona, Francisco Javier" sort="Downey Carmona, Francisco Javier" uniqKey="Downey Carmona F" first="Francisco Javier" last="Downey-Carmona">Francisco Javier Downey-Carmona</name>
<affiliation>
<nlm:aff id="Aff1">Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lagares, Araceli" sort="Lagares, Araceli" uniqKey="Lagares A" first="Araceli" last="Lagares">Araceli Lagares</name>
<affiliation>
<nlm:aff id="Aff2">Plastic Surgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Farrington Rueda, David" sort="Farrington Rueda, David" uniqKey="Farrington Rueda D" first="David" last="Farrington-Rueda">David Farrington-Rueda</name>
<affiliation>
<nlm:aff id="Aff1">Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lirola Criado, Jose" sort="Lirola Criado, Jose" uniqKey="Lirola Criado J" first="José" last="Lirola-Criado">José Lirola-Criado</name>
<affiliation>
<nlm:aff id="Aff1">Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt>
<idno type="wicri:source">PMC</idno>
<idno type="pmid">26238609</idno>
<idno type="pmc">4549351</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549351</idno>
<idno type="RBID">PMC:4549351</idno>
<idno type="doi">10.1007/s11832-015-0670-z</idno>
<date when="2015">2015</date>
<idno type="wicri:Area/Pmc/Corpus">000D59</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000D59</idno>
</publicationStmt>
<sourceDesc>
<biblStruct>
<analytic>
<title xml:lang="en" level="a" type="main">Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases</title>
<author>
<name sortKey="Downey Carmona, Francisco Javier" sort="Downey Carmona, Francisco Javier" uniqKey="Downey Carmona F" first="Francisco Javier" last="Downey-Carmona">Francisco Javier Downey-Carmona</name>
<affiliation>
<nlm:aff id="Aff1">Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lagares, Araceli" sort="Lagares, Araceli" uniqKey="Lagares A" first="Araceli" last="Lagares">Araceli Lagares</name>
<affiliation>
<nlm:aff id="Aff2">Plastic Surgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Farrington Rueda, David" sort="Farrington Rueda, David" uniqKey="Farrington Rueda D" first="David" last="Farrington-Rueda">David Farrington-Rueda</name>
<affiliation>
<nlm:aff id="Aff1">Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lirola Criado, Jose" sort="Lirola Criado, Jose" uniqKey="Lirola Criado J" first="José" last="Lirola-Criado">José Lirola-Criado</name>
<affiliation>
<nlm:aff id="Aff1">Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Journal of Children's Orthopaedics</title>
<idno type="ISSN">1863-2521</idno>
<idno type="eISSN">1863-2548</idno>
<imprint>
<date when="2015">2015</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass></textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<sec>
<title>Purpose</title>
<p>We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children.</p>
</sec>
<sec>
<title>Introduction</title>
<p>Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel–Trenaunay–Weber syndrome and Proteus syndrome.</p>
<p>The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved.</p>
</sec>
<sec>
<title>Methods</title>
<p>We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure.</p>
</sec>
<sec>
<title>Results</title>
<p>We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>We believe that island-nail transfer in children obtains excellent results.</p>
</sec>
</div>
</front>
<back>
<div1 type="bibliography">
<listBibl>
<biblStruct>
<analytic>
<author>
<name sortKey="Bhat, Ak" uniqKey="Bhat A">AK Bhat</name>
</author>
<author>
<name sortKey="Bhaskaranand, K" uniqKey="Bhaskaranand K">K Bhaskaranand</name>
</author>
<author>
<name sortKey="Kanna, R" uniqKey="Kanna R">R Kanna</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Bulut, M" uniqKey="Bulut M">M Bulut</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Dautel, G" uniqKey="Dautel G">G Dautel</name>
</author>
<author>
<name sortKey="Vialaneix, J" uniqKey="Vialaneix J">J Vialaneix</name>
</author>
<author>
<name sortKey="Faivre, S" uniqKey="Faivre S">S Faivre</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Dennyson, Wg" uniqKey="Dennyson W">WG Dennyson</name>
</author>
<author>
<name sortKey="Bear, Jn" uniqKey="Bear J">JN Bear</name>
</author>
<author>
<name sortKey="Bhoola, Kd" uniqKey="Bhoola K">KD Bhoola</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Hop, Mj" uniqKey="Hop M">MJ Hop</name>
</author>
<author>
<name sortKey="Van Der Biezen, Jj" uniqKey="Van Der Biezen J">JJ van der Biezen</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Kalen, V" uniqKey="Kalen V">V Kalen</name>
</author>
<author>
<name sortKey="Burwell, Ds" uniqKey="Burwell D">DS Burwell</name>
</author>
<author>
<name sortKey="Omer, Ge" uniqKey="Omer G">GE Omer</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Uemura, T" uniqKey="Uemura T">T Uemura</name>
</author>
<author>
<name sortKey="Kazuki, K" uniqKey="Kazuki K">K Kazuki</name>
</author>
<author>
<name sortKey="Okada, M" uniqKey="Okada M">M Okada</name>
</author>
<author>
<name sortKey="Egi, T" uniqKey="Egi T">T Egi</name>
</author>
<author>
<name sortKey="Takaoka, K" uniqKey="Takaoka K">K Takaoka</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Laliotis, N" uniqKey="Laliotis N">N Laliotis</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Fleckman, P" uniqKey="Fleckman P">P Fleckman</name>
</author>
<author>
<name sortKey="Allan, C" uniqKey="Allan C">C Allan</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Topoleski, Ta" uniqKey="Topoleski T">TA Topoleski</name>
</author>
<author>
<name sortKey="Ganel, A" uniqKey="Ganel A">A Ganel</name>
</author>
<author>
<name sortKey="Grogan, Dp" uniqKey="Grogan D">DP Grogan</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Lagoutaris, Ed" uniqKey="Lagoutaris E">ED Lagoutaris</name>
</author>
<author>
<name sortKey="Didomenico, La" uniqKey="Didomenico L">LA Didomenico</name>
</author>
<author>
<name sortKey="Haber, Ll" uniqKey="Haber L">LL Haber</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Tsuge, K" uniqKey="Tsuge K">K Tsuge</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">J Child Orthop</journal-id>
<journal-id journal-id-type="iso-abbrev">J Child Orthop</journal-id>
<journal-title-group>
<journal-title>Journal of Children's Orthopaedics</journal-title>
</journal-title-group>
<issn pub-type="ppub">1863-2521</issn>
<issn pub-type="epub">1863-2548</issn>
<publisher>
<publisher-name>Springer Berlin Heidelberg</publisher-name>
<publisher-loc>Berlin/Heidelberg</publisher-loc>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">26238609</article-id>
<article-id pub-id-type="pmc">4549351</article-id>
<article-id pub-id-type="publisher-id">670</article-id>
<article-id pub-id-type="doi">10.1007/s11832-015-0670-z</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Technical Note</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Downey-Carmona</surname>
<given-names>Francisco Javier</given-names>
</name>
<address>
<email>franciscoj.downey.sspa@juntadeandalucia.es</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lagares</surname>
<given-names>Araceli</given-names>
</name>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Farrington-Rueda</surname>
<given-names>David</given-names>
</name>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lirola-Criado</surname>
<given-names>José</given-names>
</name>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<aff id="Aff1">
<label></label>
Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</aff>
<aff id="Aff2">
<label></label>
Plastic Surgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain</aff>
</contrib-group>
<pub-date pub-type="epub">
<day>4</day>
<month>8</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>4</day>
<month>8</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="ppub">
<month>8</month>
<year>2015</year>
</pub-date>
<volume>9</volume>
<issue>4</issue>
<fpage>281</fpage>
<lpage>285</lpage>
<history>
<date date-type="received">
<day>11</day>
<month>3</month>
<year>2015</year>
</date>
<date date-type="accepted">
<day>8</day>
<month>7</month>
<year>2015</year>
</date>
</history>
<permissions>
<copyright-statement>© The Author(s) 2015</copyright-statement>
<license license-type="OpenAccess">
<license-p>
<bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p>
</license>
</permissions>
<abstract id="Abs1">
<sec>
<title>Purpose</title>
<p>We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children.</p>
</sec>
<sec>
<title>Introduction</title>
<p>Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel–Trenaunay–Weber syndrome and Proteus syndrome.</p>
<p>The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved.</p>
</sec>
<sec>
<title>Methods</title>
<p>We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure.</p>
</sec>
<sec>
<title>Results</title>
<p>We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>We believe that island-nail transfer in children obtains excellent results.</p>
</sec>
</abstract>
<kwd-group xml:lang="en">
<title>Keywords</title>
<kwd>Macrodactyly</kwd>
<kwd>Reconstruction</kwd>
<kwd>Island nail flap</kwd>
<kwd>Deformity</kwd>
</kwd-group>
<custom-meta-group>
<custom-meta>
<meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2015</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<body>
<sec id="Sec1">
<title>Background</title>
<p>Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits [
<xref ref-type="bibr" rid="CR1">1</xref>
–
<xref ref-type="bibr" rid="CR8">8</xref>
]. It is more frequent in fingers than toes, where there is less neural involvement [
<xref ref-type="bibr" rid="CR4">4</xref>
]. Nonetheless, the condition is often progressive in both [
<xref ref-type="bibr" rid="CR4">4</xref>
]. Etiology and pathogenesis is still unknown [
<xref ref-type="bibr" rid="CR5">5</xref>
]. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel–Trenaunay–Weber syndrome and Proteus syndrome [
<xref ref-type="bibr" rid="CR1">1</xref>
,
<xref ref-type="bibr" rid="CR2">2</xref>
,
<xref ref-type="bibr" rid="CR7">7</xref>
,
<xref ref-type="bibr" rid="CR9">9</xref>
].</p>
<p>Macrodactyly of the foot is usually isolated [
<xref ref-type="bibr" rid="CR2">2</xref>
]. Because the number of affected digits and growth and extent of the overgrowth varies, treatment decisions have to be made individually. The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes [
<xref ref-type="bibr" rid="CR4">4</xref>
,
<xref ref-type="bibr" rid="CR10">10</xref>
]. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means of shortening and narrowing the foot, cannot be performed [
<xref ref-type="bibr" rid="CR2">2</xref>
,
<xref ref-type="bibr" rid="CR3">3</xref>
]. In addition to this, cosmetic results are better if the nail is preserved [
<xref ref-type="bibr" rid="CR3">3</xref>
].</p>
<p>The blood supply to the nail unit originates from the proper digital arteries, proximal to the interphalangeal joint, that give off the dorsal digital branch which feeds the nail fold and matrix through the superficial arcade. The nail plate originates from the proximal nail fold and is bordered on either side by the lateral nail folds. The nail matrix is located on the ventral surface of the proximal nail fold. The phalanx is located under the nail without any dermis or subcutaneous tissue between them [
<xref ref-type="bibr" rid="CR10">10</xref>
].</p>
<p>We describe our surgical technique in two cases of macrodactyly of the first ray treated by a combination of resection of the distal phalanx, metatarsal shortening, debulking, and island nail transfer in a single-stage operation.</p>
</sec>
<sec id="Sec2" sec-type="materials|methods">
<title>Materials and methods</title>
<p>We performed a retrospective study of our first two cases of macrodactyly of the first ray treated with the island-flap technique.</p>
<sec id="Sec3">
<title>Surgical technique</title>
<p>Surgery was performed under general anesthesia and tourniquet and fluoroscopic control. The incisions were planned to ensure proper location of the nail bed and proper final toe length (Fig. 
<xref rid="Fig1" ref-type="fig">1</xref>
). First, we carefully dissected to preserve the lateral collateral artery. A longitudinal osteotomy of the dorsal aspect of the distal phalanx was performed to obtain a segment of 2–3 mm thickness with the nail complex attached (Fig. 
<xref rid="Fig2" ref-type="fig">2</xref>
). Care was taken not to damage the neurovascular bundle while the osteotomy was performed. The flexor and extensor tendons were transferred to the proximal phalanx and the remaining distal phalanx was excised.
<fig id="Fig1">
<label>Fig. 1</label>
<caption>
<p>Case 1: Preoperative radiographs (
<bold>a</bold>
) and planned incisions (
<bold>b</bold>
). Note the hatched area where the flap was to be transferred</p>
</caption>
<graphic xlink:href="11832_2015_670_Fig1_HTML" id="MO1"></graphic>
</fig>
<fig id="Fig2">
<label>Fig. 2</label>
<caption>
<p>Case 1: Intraoperative images.
<bold>a</bold>
Dissection of the nail flap.
<bold>b</bold>
Longitudinal osteotomy of the distal phalanx. Note the vessel loop protecting the neurovascular bundle</p>
</caption>
<graphic xlink:href="11832_2015_670_Fig2_HTML" id="MO2"></graphic>
</fig>
</p>
<p>After the dorsal side of the proximal phalanx was stripped of periosteum, the island nail graft was mobilized to the proximal phalanx, where the bone–nail complex was fixed with transosseous sutures (Nylon 3/0).</p>
<p>After tourniquet release, the skin was closed with interrupted non-absorbable sutures (Prolene 5/0). A bulky dressing and a lower-leg splint were applied over an aspirative drain (Fig. 
<xref rid="Fig3" ref-type="fig">3</xref>
).
<fig id="Fig3">
<label>Fig. 3</label>
<caption>
<p>Case 1: Final immediate postoperative result showing adequate perfusion of the toe</p>
</caption>
<graphic xlink:href="11832_2015_670_Fig3_HTML" id="MO3"></graphic>
</fig>
</p>
<p>Postoperatively, vascular status was monitored by simple observation and capillary refill of the tip of the toe. The patient was usually discharged at the third or fourth postoperative day.</p>
</sec>
<sec id="Sec4">
<title>Case 1</title>
<p>A 2-year-old girl was referred to our hospital for evaluation of enlarged first and second toes of her left foot. The Pediatric Orthopedic Deformity Unit and Pediatric Plastic Surgery Unit jointly evaluated her. Clinical and radiographic evaluations confirmed the diagnosis of macrodactyly of the first and second ray. Due to continued, disproportionate growth of the affected rays and difficulty in finding proper footwear, surgery was recommended.</p>
<p>Under general anesthesia and tourniquet control, we performed a complete amputation of the second ray, oblique shortening osteotomy of the first metatarsal, which was fixed with two 1.5- and 2.0-mm screws (Compact hand, Synthes
<sup>®</sup>
), and debulking. The soft tissues were closed with absorbable sutures (Vicryl 3/0) and the skin was closed with interrupted non-absorbable sutures (Prolene 4/0). An aspirative drain was left and a short leg splint was applied over a well-padded dressing.</p>
<p>Immediate postoperative follow-up was without incident. At 1-month follow-up the short-leg splint was changed for a walking cast and full weight-bearing was authorized.</p>
<p>Due to continued growth of the first ray, a second reconstructive surgery was recommended 1 year after the first. At this surgery, we performed the island nail flap, closing the soft tissues in the same manner as in the prior procedure; a short-leg splint was applied over the dressings.</p>
<p>At 1-month follow-up, the affected foot was longitudinally of the same size as the contralateral one and full weight-bearing was authorized. At 3 months postoperatively, the cosmetic result was excellent: the feet continued to be the same length. However, there was a difference of about 2 cm in width. Nonetheless, she was able to wear shoes of the same size. At present, she is awaiting further debulking surgery but the feet remain the same length (Fig. 
<xref rid="Fig4" ref-type="fig">4</xref>
).
<fig id="Fig4">
<label>Fig. 4</label>
<caption>
<p>Case 1: Clinical photograph (
<bold>a</bold>
) and radiograph (
<bold>b</bold>
) at 15 months follow-up</p>
</caption>
<graphic xlink:href="11832_2015_670_Fig4_HTML" id="MO4"></graphic>
</fig>
</p>
</sec>
<sec id="Sec5">
<title>Case 2</title>
<p>A 6-year-old female was evaluated in our clinic. She had been diagnosed with macrodactyly of the first ray with syndactyly of the second and third toes at another center, where a second and third ray amputation was performed at the age of 10 months. Clinically, she presented scars from the previous intervention and presented a lipoma on the anterior surface of the ipsilateral knee. There were no signs of Klippel–Trenaunay syndrome or neurofibromatosis, which led us to diagnose isolated macrodactyly of the foot. The child had trouble with shoe wear and cosmetic issues. Surgical correction was offered.</p>
<p>In the operating room, under general anesthesia and tourniquet and fluoroscopic control, the incisions were planned as in the previous case. However, since the lateral collateral artery and vein were carefully dissected but could not be found and the medial vascular pedicle was precarious, the dorsal vein and artery were preserved to ensure proper blood flow to the flap (Fig. 
<xref rid="Fig5" ref-type="fig">5</xref>
). The rest of the operation was performed as in the previous case. After tourniquet release, proper blood flow was observed in the flap. The skin was then closed with interrupted non-absorbable sutures (Prolene 5/0). A bulky dressing and a lower-leg splint were applied. Vascular status was monitored by simple observation and capillary refill of the tip of the toe.
<fig id="Fig5">
<label>Fig. 5</label>
<caption>
<p>Case 2: Initial clinical photograph (
<bold>a</bold>
) and radiograph (
<bold>b</bold>
)</p>
</caption>
<graphic xlink:href="11832_2015_670_Fig5_HTML" id="MO5"></graphic>
</fig>
</p>
<p>Initial follow-up was without incident but the nail was lost at 10 months postoperatively. However, the family and child were happy with the result since she wore same-sized shoes. However, as in the previous case she is awaiting debulking of the knee and foot (Fig. 
<xref rid="Fig6" ref-type="fig">6</xref>
).
<fig id="Fig6">
<label>Fig. 6</label>
<caption>
<p>Case 2: Clinical photograph (
<bold>a</bold>
) and radiograph (
<bold>b</bold>
) at 1-year follow-up</p>
</caption>
<graphic xlink:href="11832_2015_670_Fig6_HTML" id="MO6"></graphic>
</fig>
</p>
</sec>
</sec>
<sec id="Sec6" sec-type="discussion">
<title>Discussion</title>
<p>Macrodactyly of the foot is an uncommon congenital malformation in which enlargement of bones and surrounding soft tissues of the foot is observed [
<xref ref-type="bibr" rid="CR1">1</xref>
–
<xref ref-type="bibr" rid="CR8">8</xref>
]. The deformity is often progressive with less neural involvement than in hand macrodactyly [
<xref ref-type="bibr" rid="CR7">7</xref>
]. Barsky [
<xref ref-type="bibr" rid="CR6">6</xref>
] made the distinction between two types of macrodactyly: the static type, which does not grow disproportionately, and the progressive type, which enlarges at a faster rate than the rest of the foot. This second type is more frequent in the foot [
<xref ref-type="bibr" rid="CR6">6</xref>
,
<xref ref-type="bibr" rid="CR7">7</xref>
].</p>
<p>The main complaints are the impossibility of wearing same-sized shoes and abnormal gait [
<xref ref-type="bibr" rid="CR3">3</xref>
]. Therefore, the goal must be to obtain an aesthetically good-looking and “shoeable” foot [
<xref ref-type="bibr" rid="CR4">4</xref>
,
<xref ref-type="bibr" rid="CR6">6</xref>
–
<xref ref-type="bibr" rid="CR8">8</xref>
]. There is no clear time at which it is best to perform surgery. We think that surgery should be done when shoe wear is difficult or impossible or the foot has become cosmetically unacceptable.</p>
<p>There is general consensus that when the first ray is not affected, the best option is to carry out a complete ray resection [
<xref ref-type="bibr" rid="CR4">4</xref>
,
<xref ref-type="bibr" rid="CR6">6</xref>
,
<xref ref-type="bibr" rid="CR7">7</xref>
,
<xref ref-type="bibr" rid="CR9">9</xref>
,
<xref ref-type="bibr" rid="CR11">11</xref>
]. Chang et al. [
<xref ref-type="bibr" rid="CR4">4</xref>
] reported that ray resection results in the best functional and cosmetic results when the lesser toes are affected. Since the affected foot is also of increased width, ray resections also address this problem, resulting in a much narrower foot [
<xref ref-type="bibr" rid="CR4">4</xref>
,
<xref ref-type="bibr" rid="CR6">6</xref>
].</p>
<p>Since the first ray is so important in foot biomechanics and cosmesis is important (i.e., nail preservation) [
<xref ref-type="bibr" rid="CR8">8</xref>
], amputation is out of the question, and reconstructive surgery is therefore indicated [
<xref ref-type="bibr" rid="CR3">3</xref>
,
<xref ref-type="bibr" rid="CR4">4</xref>
]. The objective is to reduce the size of the ray and since no one procedure (debulking, epiphyseal arrest, shortening, etc.) can achieve this, many procedures have been developed to be performed simultaneously: debulking, total or partial ray amputation, metatarsal and/or phalangeal shortening, and epiphysiodesis [
<xref ref-type="bibr" rid="CR2">2</xref>
–
<xref ref-type="bibr" rid="CR4">4</xref>
]. Usually, repeated debulking is needed due to the progressive nature of the deformity [
<xref ref-type="bibr" rid="CR12">12</xref>
].</p>
<p>Tsuge [
<xref ref-type="bibr" rid="CR13">13</xref>
] described his method of excision of the distal phalanx using a dorsal flap while preserving the nail. The disadvantage is that this method requires 2-stage surgery about 5–6 weeks apart in order to obtain final correction.</p>
<p>Dautel et al. [
<xref ref-type="bibr" rid="CR3">3</xref>
] described their technique of island nail transfer in a 9-year-old girl with Proteus syndrome, with excellent results. We used a similar technique but with a variation. The transfer was of the whole nail complex with a portion of bone attached. We think that this should ensure better consolidation and survival of the graft instead of just the periosteum as Dautel et al. describe [
<xref ref-type="bibr" rid="CR3">3</xref>
].</p>
<p>Uemura et al. [
<xref ref-type="bibr" rid="CR8">8</xref>
] also used an island nail flap to treat a case of macrodactyly of the second toe, with excellent results. As in our case, they transferred the nail complex along with an osseous segment of the distal phalanx.</p>
<p>In our second case, the nail was lost at the 10-month follow-up period. We attribute this to the fact that the child had had previous intervention and blood flow was most likely already compromised.</p>
<p>In our opinion, an island nail transfer, along with additional surgeries, obtains excellent results in first ray macrodactyly. The toe can be shortened as needed since the nail complex, along with a portion of the distal phalanx, can be moved freely as desired. This leads to a higher rate of survival of the graft and, therefore, obtains better cosmetic results.</p>
</sec>
</body>
<back>
<notes notes-type="conflict-interest">
<title>Compliance with ethical standards</title>
<sec id="d30e565">
<title>Conflict of interest</title>
<p>The authors declare that they have no conflict of interest.</p>
</sec>
<sec id="d30e570">
<title>Informed consent</title>
<p>Informed consent was obtained from the guardians of the patients included in the study.</p>
</sec>
<sec id="d30e575">
<title>Ethical approval</title>
<p>All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p>
</sec>
</notes>
<ref-list id="Bib1">
<title>References</title>
<ref id="CR1">
<label>1.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bhat</surname>
<given-names>AK</given-names>
</name>
<name>
<surname>Bhaskaranand</surname>
<given-names>K</given-names>
</name>
<name>
<surname>Kanna</surname>
<given-names>R</given-names>
</name>
</person-group>
<article-title>Bilateral macrodactyly of the hands and feet with post-axial involvement–a case report</article-title>
<source>J Hand Surg (Eur Vol)</source>
<year>2005</year>
<volume>30</volume>
<issue>6</issue>
<fpage>618</fpage>
<lpage>620</lpage>
<pub-id pub-id-type="doi">10.1016/j.jhsb.2005.05.010</pub-id>
</element-citation>
</ref>
<ref id="CR2">
<label>2.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bulut</surname>
<given-names>M</given-names>
</name>
</person-group>
<article-title>Ray amputation for the treatment of macrodactyly in the foot: report of three cases</article-title>
<source>Acta Orthop Traumatol Turc.</source>
<year>2011</year>
<volume>45</volume>
<issue>6</issue>
<fpage>458</fpage>
<lpage>462</lpage>
<pub-id pub-id-type="doi">10.3944/AOTT.2011.2353</pub-id>
<pub-id pub-id-type="pmid">22245824</pub-id>
</element-citation>
</ref>
<ref id="CR3">
<label>3.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dautel</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Vialaneix</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Faivre</surname>
<given-names>S</given-names>
</name>
</person-group>
<article-title>Island nail transfer in the treatment of macrodactyly of the great toe: a case report</article-title>
<source>J Foot Ankle Surg</source>
<year>2004</year>
<volume>43</volume>
<issue>2</issue>
<fpage>113</fpage>
<lpage>118</lpage>
<pub-id pub-id-type="doi">10.1053/j.jfas.2004.01.004</pub-id>
<pub-id pub-id-type="pmid">15057859</pub-id>
</element-citation>
</ref>
<ref id="CR4">
<label>4.</label>
<mixed-citation publication-type="other">Chang C-H, Kumar SJ, Riddle EC, Glutting J (2002) Macrodactyly of the foot. J Bone Joint Surg Am. 84-A(7):1189–1194</mixed-citation>
</ref>
<ref id="CR5">
<label>5.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dennyson</surname>
<given-names>WG</given-names>
</name>
<name>
<surname>Bear</surname>
<given-names>JN</given-names>
</name>
<name>
<surname>Bhoola</surname>
<given-names>KD</given-names>
</name>
</person-group>
<article-title>Macrodactyly in the foot</article-title>
<source>J Bone Joint Surg Br Vol</source>
<year>1977</year>
<volume>59</volume>
<issue>3</issue>
<fpage>355</fpage>
<lpage>359</lpage>
</element-citation>
</ref>
<ref id="CR6">
<label>6.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hop</surname>
<given-names>MJ</given-names>
</name>
<name>
<surname>van der Biezen</surname>
<given-names>JJ</given-names>
</name>
</person-group>
<article-title>Ray reduction of the foot in the treatment of macrodactyly and review of the literature</article-title>
<source>J Foot Ankle Surg</source>
<year>2011</year>
<volume>50</volume>
<issue>4</issue>
<fpage>434</fpage>
<lpage>438</lpage>
<pub-id pub-id-type="doi">10.1053/j.jfas.2011.04.011</pub-id>
<pub-id pub-id-type="pmid">21601486</pub-id>
</element-citation>
</ref>
<ref id="CR7">
<label>7.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kalen</surname>
<given-names>V</given-names>
</name>
<name>
<surname>Burwell</surname>
<given-names>DS</given-names>
</name>
<name>
<surname>Omer</surname>
<given-names>GE</given-names>
</name>
</person-group>
<article-title>Macrodactyly of the hands and feet</article-title>
<source>J Pediatr Orthop</source>
<year>1988</year>
<volume>8</volume>
<issue>3</issue>
<fpage>311</fpage>
<lpage>315</lpage>
<pub-id pub-id-type="doi">10.1097/01241398-198805000-00011</pub-id>
<pub-id pub-id-type="pmid">3284905</pub-id>
</element-citation>
</ref>
<ref id="CR8">
<label>8.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Uemura</surname>
<given-names>T</given-names>
</name>
<name>
<surname>Kazuki</surname>
<given-names>K</given-names>
</name>
<name>
<surname>Okada</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Egi</surname>
<given-names>T</given-names>
</name>
<name>
<surname>Takaoka</surname>
<given-names>K</given-names>
</name>
</person-group>
<article-title>A case of toe macrodactyly treated by application of a vascularised nail graft</article-title>
<source>Br J Plast Surg</source>
<year>2005</year>
<volume>58</volume>
<issue>7</issue>
<fpage>1020</fpage>
<lpage>1024</lpage>
<pub-id pub-id-type="doi">10.1016/j.bjps.2005.05.013</pub-id>
<pub-id pub-id-type="pmid">16039630</pub-id>
</element-citation>
</ref>
<ref id="CR9">
<label>9.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Laliotis</surname>
<given-names>N</given-names>
</name>
</person-group>
<article-title>Congenital gigantism of the foot</article-title>
<source>Foot Ankle Surg (Elsevier)</source>
<year>2001</year>
<volume>7</volume>
<issue>4</issue>
<fpage>201</fpage>
<lpage>205</lpage>
<pub-id pub-id-type="doi">10.1046/j.1460-9584.2001.00266.x</pub-id>
</element-citation>
</ref>
<ref id="CR10">
<label>10.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fleckman</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Allan</surname>
<given-names>C</given-names>
</name>
</person-group>
<article-title>Surgical anatomy of the nail unit</article-title>
<source>Dermatol Surg</source>
<year>2001</year>
<volume>27</volume>
<issue>3</issue>
<fpage>257</fpage>
<lpage>260</lpage>
<pub-id pub-id-type="pmid">11277893</pub-id>
</element-citation>
</ref>
<ref id="CR11">
<label>11.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Topoleski</surname>
<given-names>TA</given-names>
</name>
<name>
<surname>Ganel</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Grogan</surname>
<given-names>DP</given-names>
</name>
</person-group>
<article-title>Effect of proximal phalangeal epiphysiodesis in the treatment of macrodactyly</article-title>
<source>Foot Ankle Int</source>
<year>1997</year>
<volume>18</volume>
<issue>8</issue>
<fpage>500</fpage>
<lpage>503</lpage>
<pub-id pub-id-type="doi">10.1177/107110079701800807</pub-id>
<pub-id pub-id-type="pmid">9278744</pub-id>
</element-citation>
</ref>
<ref id="CR12">
<label>12.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lagoutaris</surname>
<given-names>ED</given-names>
</name>
<name>
<surname>Didomenico</surname>
<given-names>LA</given-names>
</name>
<name>
<surname>Haber</surname>
<given-names>LL</given-names>
</name>
</person-group>
<article-title>J Am Podiatr Med Assoc</article-title>
<source>Foot Ankle Int</source>
<year>2004</year>
<volume>94</volume>
<issue>5</issue>
<fpage>499</fpage>
<lpage>501</lpage>
</element-citation>
</ref>
<ref id="CR13">
<label>13.</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tsuge</surname>
<given-names>K</given-names>
</name>
</person-group>
<article-title>Treatment of macrodactyly</article-title>
<source>Plast Reconstr Surg</source>
<year>1997</year>
<volume>39</volume>
<issue>6</issue>
<fpage>590</fpage>
<lpage>599</lpage>
<pub-id pub-id-type="doi">10.1097/00006534-196706000-00008</pub-id>
<pub-id pub-id-type="pmid">6025687</pub-id>
</element-citation>
</ref>
</ref-list>
</back>
</pmc>
</record>

Pour manipuler ce document sous Unix (Dilib)

EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/LymphedemaV1/Data/Pmc/Corpus

HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000D59 | SxmlIndent | more

Ou

HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000D59 | SxmlIndent | more

Pour mettre un lien sur cette page dans le réseau Wicri

{{Explor lien
   |wiki=    Wicri/Sante
   |area=    LymphedemaV1
   |flux=    Pmc
   |étape=   Corpus
   |type=    RBID
   |clé=     PMC:4549351
   |texte=   Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases
}}

Pour générer des pages wiki

HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i   -Sk "pubmed:26238609" \
       | HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd   \
       | NlmPubMed2Wicri -a LymphedemaV1
Wicri

This area was generated with Dilib version V0.6.31.
Data generation: Sat Nov 4 17:40:35 2017. Site generation: Tue Feb 13 16:42:16 2024