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2008 | 80 | 8 | 394-403
Article title

Results of Surgical and Postoperative Treatment of Syndactyly in Epidermolysis Bullosa

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EN
Abstracts
EN
Use of small autologous skin grafts or leaving the defects and waiting for their spontaneous reepidermization are one of the methods of wound management after surgical treatment of hand contractures in Epidermolysis bullosa. This techniques are believed to allow quick wound healing, however this does not seem universally possible.The aim of the study was to assess healing rate and incidence of early recurrence after using of both techniques.Material and methods. Eleven operations of hand contracture were performed, including two recurrent cases after previous surgeries. Skin grafts were used in eight cases. Kirshner wires were not used and the fingers were stabilized in an extended position only with a supportive dressing. In the early postoperative period, dressings were made in the operation room and patients were admitted for 24-hour hospitalizations no more than once a week.Results. Complete healing before day 35 was achieved only in five cases. In the remaining cases, dressings in the operating room were abandoned between day 35 and 40 and the patients were referred to further treatment in the outpatient setting. Outpatient dressings were done without anesthesia which in the event of unhealed spaces between the fingers, seemed to impair their separation and facilitate early recurrences of syndactyly. Two cases of early recurrence (18%), during the first year after the operation, were noted in one patientConclusions. Our results indicate that the postoperative wound healing does not depend on the use of skin grafts and can be much longer than some previous studies suggested. This shortens the period of full efficiency between the recurrences. Clinical observations also indicate that this affects the risk of early recurrences. Despite that, their number is similar to the value considered good in the literature.
Publisher

Year
Volume
80
Issue
8
Pages
394-403
Physical description
Dates
published
1 - 8 - 2008
online
10 - 9 - 2008
Contributors
  • Department of Plastic Surgery, Medical Centre of Postgraduate Education, Warsaw
  • Department of Pediatric Surgery, Prof. Bogdanowicz Memorial Hospital, Warsaw
author
  • Department of Plastic Surgery, Medical Centre of Postgraduate Education, Warsaw
  • Department of Pediatric Surgery, Prof. Bogdanowicz Memorial Hospital, Warsaw
  • Department of General and Vascular Surgery, Medical University, Warsaw
References
  • Noszczyk B, Jethon J: Leczenie chirurgiczne w Epidermolysis bullosa. Pol Przegl Chir 2008; 5(80): 485-96.
  • Bielecki M, Skowroński J, Skowroński R: Chirurgiczne leczenie przykurczów palców i pseudosyndaktylii w dystroficznej formie pęcherzycy - demonstracja przypadku i przegląd piśmiennictwa. Polish Hand Surgery 2004; 1(35): 29-38.
  • Ladd AL, Eggleston JM: Hand management for patients with epidermolysis bullosa. W: Mathes SJ, (red.) Plastic Surgery, Second Edition, Saunders Elsevier Philadelphia, 2005, vol. VIII: 431-38.
  • Fine JD, Johnson LB, Weiner M et al.: Pseudosyndactyly and musculoskeletal contractures in inherited epidermolysis bullosa: experience of the National Epidermolysis Bullosa Registry, 1986-2002. J Hand Surg [Br]. 2005; 30(1): 14-22.
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  • Marín-Bertolín S, Amaya Valero JV, Neira Giménez C et al.: Surgical management of hand contractures and pseudosyndactyly in dystrophic epidermolysis bullosa. Ann Plast Surg 1999; 43(5): 555-59.
  • Ladd AL, Kibele A, Gibbons S: Surgical treatment and postoperative splinting of recessive dystrophic epidermolysis bullosa. J Hand Surg [Am] 1996; 21(5): 888-97.[Crossref]
  • Terrill PJ, Mayou BJ, Pemberton J: Experience in the surgical management of the hand in dystrophic epidermolysis bullosa. Br J Plast Surg 1992; 45(6): 435-42.[PubMed]
  • Ciccarelli AO, Rothaus KO, Carter DM et al.: Plastic and reconstructive surgery in epidermolysis bullosa: clinical experience with 110 procedures in 25 patients. Ann Plast Surg 1995; 35(3): 254-61.
  • Witt PD, Cheng CJ, Mallory SB et al.: Surgical treatment of pseudosyndactyly of the hand in epidermolysis bullosa: histological analysis of an acellular allograft dermal matrix. Ann Plast Surg 1999; 43(4): 379-85.
  • Fivenson DP, Scherschun L, Cohen LV: Apligraf in the treatment of severe mitten deformity associated with recessive dystrophic epidermolysis bullosa. Plast Reconstr Surg 2003; 112(2): 584-88.[PubMed][Crossref]
  • Fine JD. Epidermolysis bullosa: a genetic disease of altered cell adhesion and wound healing, and the possible clinical utility of topically applied thymosin beta4. Ann N Y Acad Sci 2007; 1112: 396-406.[WoS]
  • Wong T, Gammon L, Liu L et al.: Potential of Fibroblast Cell Therapy for Recessive Dystrophic Epidermolysis Bullosa. J Invest Dermatol 2008; Apr 3.[WoS]
Document Type
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-008-0056-8
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