Monday, July 5, 2021

Syndactyly, Macrodactyly, and Keloid

The treatment of syndactyly is highly successful, no matter the preferred technique. That is the classic technique of Flatt (dorsal commissure flap and zig- zag incisions- ) or graftless techninques or hyalomatrix- all can work. Complications include web creep (maybe not a true complication as it is so commonly seen), wound healing issues, rare infections, etc. Hypertrophic scarring is very, very uncommon. However, with macrodactyly there is a risk of keloid formation. While we do not understand this, it is likely related to PIK3CA . While macrodactyly may be dramatic, it can also be subtle and bears the surgeon's close attention. Here is one view of a patient's syndactyly and a few surgeries immediately after surgery.
The family chose to work with dermatology and that decision has worked out very well, now more than 2 years out from surgery. Silicone sheeting and applying a topical corticosteroid, clobetesol propionate usp 0.5%, has led to dramatic improvement in the keloid.
These are very difficult decisions and, needless to say, I am pleased this has worked out well. The use of methotrexate is not new (> 40 year history) for keloid but the attention to this treatment option was raised by Ezaki (As noted above) and by Tonkin. The excellent outcome here will likely influence my decision for treatment options in patients who delveop keloid after syndactyly reconstruction. But, the other important question is around patients who with macrodactyly and syndactyly- should we always use methotrexate in those patients at the time of the syndactyly reconstruction? Thanks for reading, Charles A. Goldfarb, MD My Bio at Washington University email: congenitalhand@wustl.edu Please CLICK HERE to support our research. Designate my name. Thank you!