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49. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPÄRC), 42. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 16. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC)

29.09. - 01.10.2011, Innsbruck

Resolution of the pseudo-syndactyly and hand "bag" in patients with epidermolysis bullosa (EB)

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  • author Fedele Lembo - Plastic and Reconstructive Surgery Department, Faculty of Medicine, Ospedali Riuniti Foggia, Italy
  • Parisi Domenico - Plastic and Reconstructive Surgery Department, Faculty of Medicine, Ospedali Riuniti Foggia, Italy
  • Portincasa Aurelio - Plastic and Reconstructive Surgery Department, Faculty of Medicine, Ospedali Riuniti Foggia, Italy

Österreichische Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie. Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 49. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPÄRC), 42. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 16. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Innsbruck, 29.09.-01.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgpraecV12

doi: 10.3205/11dgpraec012, urn:nbn:de:0183-11dgpraec0124

Published: September 27, 2011

© 2011 Lembo et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: Epidermolysis bullosa (EB) is a rare congenital disorder with blistering skin caused by minimal trauma. The hand, exposed to repeated microtraumatic, is one of the bodies "target". Authors present the experience in treatment of pseudo-syndactyly and "hand bag" with microsurgical technique and advanced device.

Material and Methods: From January 2001-2010, were treated 21 patients (12M, 9F), mean 14.5 years (3-46). Under local anesthesia and sedation, short-term profilaxis, analgesia post-op, 51 hands treated with opening of interdigital spaces preserving vessels and nerves, allowing coverage of the nervous-vascular pedicle with vascularized connective-adipose local flaps. Immobilization: splint with elastic rebound until 2008 (16 cases) and Kirshner in remaining 5 cases. In recent cases (4 hands) model of "glove" with dermal inducer device (Integra ®), with more fast and efficient re-epithelialization in absence of spontaneous pain. Average hospitalization was twenty-two days (first series), four days (last series). Removing glove and Kirshner: 28-32 days.

Results: No major complications. Mean “free interval”: 2.5 to 4.6 years. Intregra® reduces postoperative pain, providing a faster recovery by the fourth week. Follow-up of 48 months shows partial recovery of the wrist-hand (MF> 40 °, IP> 25 °, ID> 10 °), resolution of pseudo-syndactyly of long fingers, opening of first interdigital space (> 60 °).

Conclusion: Authors believe that the protocol developed has the following advantages: it reduces risk of iatrogenic injury to the nervous-vascular pedicle, protects joints from digital ankylosis, reduces the hospital stay, improve patient compliance, allows long-term medications, allows a durable functional recovery.