Experience treating syndactyly.
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When the entire digital web space has been destroyed by burn scarring and there is a contracture of the volar aspect of the web as well as the dorsum, Z-plasties and skin grafts alone seldom produce a satisfactory web space. During the past 3 years, for the release of 46 contracted web spaces in 20 burned patients, we have turned a rectangular flap from the dorsal surface of the web through into an inverted-T incision in the palm. The adjacent sides of the defects have been skin grafted. In all these patients, we obtained satisfactory release of the contracture and restoration of the web space.
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We report a fetus with micrognathia, cleft palate, polysyndactyly, brachycephaly and proximal radial hypoplasia. We believe the abnormalities represent a new syndrome not previously described.
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A mother and daughter with metacarpal and metatarsal asymmetry, tarsal and carpal fusions, long bone articular dysplasia and platyspondyly are reported as a possible autosomal dominant syndrome affecting skeletal development. The asymmetry of the second metacarpals is perhaps the most striking finding and resulted in a range of bone lengths in the two individuals from minus 6.3 to plus 3.7 standard deviations from the mean.
Clinical and autopsy findings in two fetuses and one newborn infant with Fraser syndrome are presented. Discussion focuses on the range of phenotypic expression within this autosomal-recessive disorder, the resulting difficulties in prenatal and postnatal diagnosis, and on the concept of a neurocristopathy as underlying disturbance.
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