gms | German Medical Science

Objectives/Interrogation: The purpose of this study is to investigate long term surgical outcomes after syndactyly release by Japanese Society for Surgery of the Hand Evaluation form (JSSH form) and patient-reported outcomes.

Methods: Eleven patients of 15 hands were included in this study. Involved fingers were 3 index/middle finger, 10 middle/ring, 1 ring/little and 1 middle/ring/little. Ten hands were simple syndactyly (6 showed the complete type, 4 the incomplete type) and 5 hands were complex syndactyly. We used dorsal rectangular flap to create the web and volar triangular flap with full-thickness skin graft for 12 hands, and dorsal Y flap for 3 hands of incomplete type. Of 15 hands, eight hands had undergone a revision surgery. All patients were directly assessed and interviewed. JSSH form includes function (joint contracture), cosmesis (web creep, skin pigmentation, nail deformity, finger deformity, scar quality) and subjective assessment (pain, patient satisfaction). Patient-reported outocomes include Quick DASH and HAND 10, then overall cosmetic appearance was rated in five grades.

Result: An average follow-up interval after the first surgery was 13.5 years (range, 7-21 y). JSSH evaluation form averaged 14.1 points; 4 hands were excellent, 3 good, 5 fair, and 3 hands were poor. Q-DASH averaged 0.4 (0-2.27) and HAND10 averaged 1.63 (0-7). The overall cosmetic appearance averaged 2.6 (1-4). Simple syndactyly showed better outcome compared with complex syndactyly. All patients showed functionally good, but cosmetic factors effected on patient satisfaction. JSSH evaluation reflected well both function and cosmesis.

Conclusion: After long-term follow-up, the most of patients maintained good function, but nail and finger deformities caused poor satisfaction. JSSH evaluation form which includes functional and cosmetic factors is appropriate to assess overall patient condition.