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At least 163 records · Page 9Linked to original sources

The double opposing palmar flaps in complex syndactyly.

Double opposing flaps on the palmar surface were designed to create nail folds and to cover bony defects of the distal phalanges in the treatment of complex syndactyly. This is a two-stage procedure, and the flaps were used on 10 hands in 8 patients. There were no failures, and the results were satisfactory after a mean follow-up time of 2 1/2 years. The two stages were performed 2 weeks apart, and the surgery can be done as an outpatient procedure.

Ambulatory Surgical Procedures↗

Infantile digital fibromatosis after web construction in syndactyly.

A case of infantile digital fibromatosis with an unusual onset is reported. A Japanese girl, with a simple syndactyly of the right ring and little fingers, had an operation at the age of 2 1/2 years. Three months after the operation, multiple nodules appeared at the skin graft edge. The nodules were excised but soon recurred. When the patient was 8 years old, a large-scale excision of the tumors was performed. Intracytoplasmic inclusion bodies were shown by phosphotungstic acid-hematoxylin stain, and the case was diagnosed as infantile digital fibromatosis.

Female↗

Evaluation of a uniform operative technique to treat syndactyly.

Twenty-two patients with upper extremity syndactyly (58 webs) have been treated in the last decade (1976 to 1985) by one hand surgeon using one technique. Nineteen patients had syndrome complexes or other associated anomalies that made treatment more difficult. The postoperative follow-up averaged 4 years. The rate of complications that necessitated repeat operations (5% of the treated webs) was relatively low in comparison with those in other series. We attribute this to better timing of the procedure and progressive experience gained by one surgeon using the same procedure.

Child↗

The thumb in syndactyly.

Syndactyly of the thumb is a rare but very serious malformation. It produces a loss of the grasping function of the thumb, which is the main function of the human hand. The author presents different methods for the reconstruction of the first web space and a functional thumb. The surgical methods of reconstruction depend upon the extend and type of the malformation. The opening of the deep intermuscular fascia of the first web is a most important step of the procedure.

Humans↗

[Syndactyly: an angiographic study].

Systematic angiographic examination (87 angiographies) done in all the congenital malformations of the hand and in particular in cases of syndactyly in patients 6-11 years of age, has given the authors the opportunity to observe anomalies of the vascular topography of the hand (distal displacement of the bifurcation of the common digital arteries, anomalies of excess or lack of arteries of the palm: common digital arteries, proper digital arteries, etc.) and of performing surgery carefully according to the angiographic appearance of the malformation.

Acrocephalosyndactylia↗

Syndactyly of Ft/+ mice correlates with an imbalance in bmp4 and fgf8 expression.

The most obvious phenotype of Ft/+ mice is a syndactyly of fore limbs characterised by a fusion of the tips of digits 1 to 4. The tempospatial expression of genes involved in limb development revealed that patterning of Ft/+ limb buds is not affected by the mutation. However, an upregulation of Bmp4 in the anterior-distal region of the limb bud at d12.0 of embryonic development is accompanied by a loss of Fgf8 expression in the distal part of the AER. Downstream target genes of Bmp action such as Msx1 and 2 are upregulated. This induction of the signalling cascade indicates ectopic expression of functional Bmp4. Nevertheless, analysis of physical parameters of bones from adult mice revealed a reduction of the bone mass of the autopod. The data suggest a negative effect of Bmp4 on Fgf8 expression and a positive influence on the induction of bone elements.

Animals↗

The use of split thickness skin grafts in the correction of Apert's syndactyly.

Stiffness of the interphalangeal joints of the fingers is a constant feature of Apert's syndrome. Because of this stiffness, the author has used split-thickness skin grafts when correcting Apert's syndactyly, thinking that contraction of such grafts post-operatively would not cause any joint contracture or finger deviation. This paper reports the results of eight patients whose average age at first surgery was 6 months. Separation of all digits was accomplished before the age of 2 years. A dorsal rectangular flap and interposing triangular digital flaps were utilised to create the web space and partially cover the skin defects in the fingers. The remaining digital defects were covered with thin split-thickness skin grafts which took fully in all cases. At final follow-up (1-6 years), the areas covered by skin grafts have reduced in size significantly because of skin graft contraction. However, this did not result joint contracture or digital deviation.

Acrocephalosyndactylia↗

The open finger technique for the release of syndactyly.

A new technique of syndactyly release is described. The technique differs from the standard methods in that more digital flaps are used, and these are longer and are not defatted. A single stitch is applied to secure the tip of the flap and the defects between the flaps are not closed or grafted, hence the term "open" technique. Eight patients had 12 webs released using this operation. We compare this technique with 12 patients who had a total of 19 webs released using the standard technique. Patients were assessed for six parameters of operative success.

Adolescent↗

Loss of nidogen-1 and -2 results in syndactyly and changes in limb development.

Nidogens are two ubiquitous basement membrane proteins produced mainly by mesenchymal cells. Nidogen-mediated interactions, in particular with laminin, collagen IV, and perlecan have been considered important in the formation and maintenance of the basement membrane. However, whereas mice lacking both nidogen isoforms or carrying mutations in the high affinity nidogen-binding site upon the laminin gamma1 chain have specific basement membrane defects in certain organs, particularly in the lung, characterization of these mice has also shown that basement membrane formation per se does not need nidogens or the laminin-nidogen interaction. Limb development requires the complex interplay of numerous growth factors whose expression is dependent upon the apical ectodermal ridge. Here, we show that lack of nidogen-1 and -2 results in a specific and time-limited failure in the ectodermal basement membrane of the limb bud. The absence of this basement membrane leads to aberrant apical ectodermal ridge formation. It also causes altered distribution of growth factors, such as fibroblast growth factors and leads to a fully penetrant soft tissue syndactyly caused by the dysregulation of interdigital apoptosis. Further, in certain animals more severe changes in bone formation occur, providing evidence for the interplay between growth factors and the extracellular matrix.

Animals↗

Correction of syndactyly: advantages with a non-grafting technique and the use of absorbable skin sutures.

Correction of syndactyly without skin grafts is simple and reliable. Combined with an absorbable suture technique the non-grafting method is further advantageous minimising risks and saving time and costs. Three methods are compared: skin grafts plus monofilament polyamide (Ethilon, Ethicon) (n = 32), no skin grafts plus Ethilon (n = 19), and no skin grafts plus polyglactin 910 (Vicryl rapide, Ethicon) (n = 9). The two groups in which grafting was not used had significantly shorter operations (mean 86 minutes compared with 118 minutes) and fewer complications. They also required fewer operations and spent less time in hospital.

Child, Preschool↗

Roles for laminin in embryogenesis: exencephaly, syndactyly, and placentopathy in mice lacking the laminin alpha5 chain.

Laminins are the major noncollagenous glycoproteins of all basal laminae (BLs). They are alpha/beta/gamma heterotrimers assembled from 10 known chains, and they subserve both structural and signaling roles. Previously described mutations in laminin chain genes result in diverse disorders that are manifested postnatally and therefore provide little insight into laminin's roles in embryonic development. Here, we show that the laminin alpha5 chain is required during embryogenesis. The alpha5 chain is present in virtually all BLs of early somite stage embryos and then becomes restricted to specific BLs as development proceeds, including those of the surface ectoderm and placental vasculature. BLs that lose alpha5 retain or acquire other alpha chains. Embryos lacking laminin alpha5 die late in embryogenesis. They exhibit multiple developmental defects, including failure of anterior neural tube closure (exencephaly), failure of digit septation (syndactyly), and dysmorphogenesis of the placental labyrinth. These defects are all attributable to defects in BLs that are alpha5 positive in controls and that appear ultrastructurally abnormal in its absence. Other laminin alpha chains accumulate in these BLs, but this compensation is apparently functionally inadequate. Our results identify new roles for laminins and BLs in diverse developmental processes.

Animals↗

Mutation of the gene encoding fibrillin-2 results in syndactyly in mice.

Fibrillins are large, cysteine-rich glycoproteins that form microfibrils and play a central role in elastic fibrillogenesis. Fibrillin-1 and fibrillin-2, encoded by FBN1 on chromosome 15q21.1 and FBN2 on chromosome 5q23-q31, are highly similar proteins. The finding of mutations in FBN1 and FBN2 in the autosomal dominant microfibrillopathies Marfan syndrome (MFS) and congenital contractural arachnodactyly (CCA), respectively, has highlighted their essential role in the development and homeostasis of elastic fibres. MFS is characterized by cardiovascular, skeletal and ocular abnormalities, and CCA by long, thin, flexed digits, crumpled ears and mild joint contractures. Although mutations arise throughout FBN1, those clustering within exons 24-32 are associated with the most severe form of MFS, so-called neonatal MFS. All the mutations described in CCA occur in the "neonatal region" of FBN2. Both MFS and CCA are thought to arise via a dominant negative mechanism. The analysis of mouse mutations has demonstrated that fibrillin-1 microfibrils are mainly engaged in tissue homeostasis rather than elastic matrix assembly. In the current investigation, we have analysed the classical mouse mutant shaker-with-syndactylism using a positional candidate approach and demonstrated that loss-of-function mutations outside the "neonatal region" of Fbn2 cause syndactyly in mice. These results suggest that phenotypes distinct from CCA may result in man as a consequence of mutations outside the "neonatal region" of FBN2.

Amino Acid Sequence↗

Localization of the syndactyly type II (synpolydactyly) locus to 2q31 region and identification of tight linkage to HOXD8 intragenic marker.

Syndactyly type II (SynPolyDactyly; SPD) is an autosomal dominant condition with incomplete penetrance and variable expressivity. Sixty-two meioses from a kindred with 425 individuals were used to map the SPD locus to 2q31 region, approximately 1.7 cM (Lod score = 12.96) centromeric to HOXD8 intragenic marker. Other homeobox-containing genes in this region have previously been ordered as cen-DLX1/DLX2-EVX2-(5' --> HOXD13..HOXD8.HOXD1 --> 3')-tel')-tel. A single recombinant with HOXD8 excluded the most 3' end of HOXD cluster as a candidate site for SPD, but a mutation in the 5' end of HOXD cluster, especially in HOXD13, EVX2 or DLX2/DLX1, may still be responsible for this phenotype. An updated order of D2S142-D2S111-(D2S335/D2S333)-D2S326-D2 S1238-SPD- (HOXD8/D2S1244)-(D2S300/D2S138)-D2S148- D2S324- D2S1384-D2S434 [sequence:see text] was deduced from meiotic recombination events.

Base Sequence↗

New modified method for the surgical treatment of syndactyly.

We have been using Marumo's method for the surgical treatment of syndactyly. However, this method presents difficulties with incision designs, which we solved by devising a modified method. This method uses an angulated rectangular dorsal flap and a triangular miniflap made at the end of the dorsal flap. By rotating this miniflap proximally, the skin defect produced at the dorsal base of the digit after removal of the angulated dorsal rectangular flap becomes triangular. This triangular skin defect can be adequately covered by the triangular flap produced at the ventral side. In the article we describe this new operative method in detail and present cases to which the method has been applied.

Fingers↗

Combination of unilateral polydactyly, syndactyly, and clinodactyly with occipitocervical encephalocele and vertebral fusion.

This report describes a 6-year-old Mexican boy presenting with inter alia, hitherto unrepaired cervical encephalocele and associated unilateral syndactyly. There was also ipsilateral clinodactyly of the thumb and possible polydactyly of the foot. In addition, there was unilateral fusion of the first and second cervical vertebrae and a Chiari type III malformation. Motor and language skills were grossly normal for age, with the exception of mild left hemiparesis affecting the arm more than the leg. Medical history was significant for incidental drainage from the encephalocele as well as occasional high fevers and possible episodes of central nervous system infection. The clinical findings were not consistent with Meckel-Gruber or any other well-recognized syndrome. It is our contention that this case documents a previously unreported constellation of congenital anomalies and, as such, may suggest a teratological insult or a new syndrome. Surgical repair was carried out with meticulous excision of dysplastic neural tissue, relocation of neural tissue within the thecal sac, and coverage of the repair site with a trapezius muscle flap. Skin was closed directly. Postoperative recovery was largely uneventful, with the exception of a seroma in the donor muscle bed.

Abnormalities, Multiple↗

Dividing the fingers in congenital syndactyly release: a review of more than 200 years of surgical treatment.

In three specific eras the approach to the dividing of the fingers in syndactyly release has changed. In the 19th century "straight cutting" or local flaps were used; then in the beginning of the 20th century skin grafts were introduced. After Cronin published work on zigzag incisions, combinations of zigzag incisions, flaps, and grafts came into use. Here, we present a review of the most important technique, given in a historical perspective.

Fingers↗

Lateral-volar finger flap for the treatment of burn syndactyly.

To completely open the web space in burn syndactyly and provide tissue that is pliable and elastic, we describe a flap from the lateral and volar surfaces of an adjacent finger which will completely cover the opened defect. The results of this procedure in 24 web spaces are reported.

Adolescent↗

An operation for syndactyly, and its results.

We describe our method of operation for syndactyly repair and our results in 62 patients (74 hands, 143 commissures), all treated more than two years ago. The operation was performed on patients aged from 17 months to two years (except those with acrosyndactyly). Postoperative web formation was not seen in any of these patients.

Acrocephalosyndactylia↗