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% |