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Table 9 Recommendations for hand surgery

From: Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence)

  Grade Consensus agreement
R9.47 It is mandatory to check all the upper limb in order to identify any malformations (shoulder, elbow) associated with hand anomalies Definitely useful/strong literature 100%
R9.48 Reconstructive planning should be adapted to the type of deformity of the hand Definitely useful/strong literature 100%
R9.49 The correction of syndactyly should begin between 12 and 24 months of life; if the first web space is involved, surgery should be performed between 6 and 12 months. Definitely useful/strong literature 100%
R9.50 If phalanx are absent, two options should be proposed to the parents: microvascular digital transfer from the foot or non-microvascular free phalangeal transfer from the foot Definitely useful/strong literature 100%
R9.51 The patient must be followed until the end of skeletal growth because recurrence of syndactyly, secondary to scar hypetrophy, may be possible Definitely useful/strong literature 100%
R9.52 When a recurrence occurs, it should be corrected during adolescence in order to reach a definitive result Definitely useful/strong literature 100%
R9.53 We recommend to use the following classification (useful for treatment therapeutic of hand function) of Hand and Upper Limb anomalies in PS:
I Absence of hand/upper limb anomalies
II Hypoplastic hand without morphologic and functional anomalies
III Symbrachydactyly with 5 functional fingers and possible morphologic anomalies of the phalanges
and partial range of motion (ROM)
IV Symbrachydactyly with some functional fingers
V Symbrachydactyly with absent or nonfunctioning fingers
VI Classic hand anomalies of PS with proximal radioulnar synostosis
VII Classic hand anomalies of PS with congenital high scapula
VIII Other associated anomalies
Definitely useful/strong literature 100%
R9.54 Types I and II (R2.11) do not need any surgical treatments, which, however, is necessary for type III and, in particular, for types IV and V, to improve hand function Definitely useful/strong literature 100%
R9.55 The reconstruction of the second and third webspaces can be delayed until 18 months of age without adverse effect on hand function or fine motor development Definitely useful/strong literature 100%
R9.56 Early surgery is recommended for border digits as syndactyly between digits of disparate length may result in flexion contracture or angular deformity. Definitely useful/strong literature 100%
R9.57 Minor syndactyly, such as observed in PS, can be treated by the usual methods of local enlargement plasty of the first commissure: trident plasty (YV double Z), Z plasty at four tatters Definitely useful/strong literature 100%
R9.58 The use HA scaffold for skin regeneration in syndactyly release surgery in young children represent a valid alternative to the use of skin grafts Definitely useful/strong literature 100%
R9.59 The first wound care is recommended after 3 weeks post-surgery Definitely useful/strong literature 66,7%