New Classification of Polydactyly of the Foot on the Basis of Syndactylism, Axis Deviation, and Metatarsal Extent of Extra Digit

Background  Polydactyly of the foot is one of the most frequent anomalies of the limbs.However, most classification systems are based solely on morphology and tend to be inaccu­rate and lessrelevantto surgical methods and results. The purpose ofthisstudy isto presentour newclassification of polydactyly ofthe foot,which can serve as a predictor oftreatmentand prognosis.Methods  To find a correlation between the various morphologic traits of polydactyly ofthe foot and the treatment plan and outcomes,we reviewed 532 cases of polydactyly ofthefoot in 431 patients treated in our hospital, expanding on our previous study that describedpolydactyly based on the importance of metatarsal bone status and varus deformity. Therecords of patientswere evaluated and comparedwith previousstudies at other centers.Results  Unsatisfactory results were seen in 36 cases, which included 5 cases of incompleteseparation due to syndactylism, 23 cases of axis deviation, and 8 cases ofremnants of extra­digit metatarsal bones. The locus of the polydactyly, or the digit which wasinvolved, did notseemto affectthe final postoperative outcomesin ourstudy. Three factors­syndactylism, axisdeviation, and metatarsal extension­are the major factors related to treatment strategy andprognosis. Therefore,we developed a newclassification systemusing three characters(S,A,M)followed by three groups(0, 1, 2),to describe the complexity of polydactyly ofthe foot,suchas S1A2M2.Conclusions  Our newclassification could provide a communicable description to help deter­mine the surgical plan and predict outcomes

Surgical Options for Malignant Skin Tumors of the Hand

BackgroundPrimary malignant tumors of the hand, although unusual, may present varied and often complex clinical problems. The main treatment modality of skin cancer of the hand has changed.MethodsWe retrospectively reviewed the medical records of 43 patients who underwent surgery for malignant skin tumors of the hand during an 18-year period, from September 1994 to February 2012. The characteristics of the tumor, methods of reconstruction, and long-term results were reviewed.ResultsWe had 43 patients with 27 melanomas, 14 squamous cell carcinomas, and 2 sarcomas. Their ages ranged from 19 to 74 years (mean, 53.4±14.5 years), from 46 to 79 years (mean, 59.7±9.6 years), and from 15 to 43 years (mean, 29±19.8 years), respectively. Thirty-four cases occurred on the fingertip (16 of those cases on the thumb), 5 cases occurred on the palm, and 4 cases on the dorsum of the hand. Amputation was most frequently used in early cases, but recently, tissue-sparing excision has been performed frequently. The incidence of local recurrence was 3 cases and distant metastasis was 1 case, and the 5-year survival rate was 100%, except in 4 cases due to follow-up loss.ConclusionsThe principles of treatment-to be curative and to preserve function and appearance-are important points. "Preservative surgery" preserves function and cosmesis of the involved finger or hand dorsum or palm. Preservative surgery not only emphasizes less resection and surgery of a smaller scale, but also optimal reconstruction of the soft tissue defect of the digit

New Classification of Polydactyly of the Foot on the Basis of Syndactylism, Axis Deviation, and Metatarsal Extent of Extra Digit

BackgroundPolydactyly of the foot is one of the most frequent anomalies of the limbs. However, most classification systems are based solely on morphology and tend to be inaccurate and less relevant to surgical methods and results. The purpose of this study is to present our new classification of polydactyly of the foot, which can serve as a predictor of treatment and prognosis.MethodsTo find a correlation between the various morphologic traits of polydactyly of the foot and the treatment plan and outcomes, we reviewed 532 cases of polydactyly of the foot in 431 patients treated in our hospital, expanding on our previous study that described polydactyly based on the importance of metatarsal bone status and varus deformity. The records of patients were evaluated and compared with previous studies at other centers.ResultsUnsatisfactory results were seen in 36 cases, which included 5 cases of incomplete separation due to syndactylism, 23 cases of axis deviation, and 8 cases of remnants of extra-digit metatarsal bones. The locus of the polydactyly, or the digit which was involved, did not seem to affect the final postoperative outcomes in our study. Three factors-syndactylism, axis deviation, and metatarsal extension-are the major factors related to treatment strategy and prognosis. Therefore, we developed a new classification system using three characters (S, A, M) followed by three groups (0, 1, 2), to describe the complexity of polydactyly of the foot, such as S1A2M2.ConclusionsOur new classification could provide a communicable description to help determine the surgical plan and predict outcomes

Three-Dimensional Pre-Bent Titanium Implant for Concomitant Orbital Floor and Medial Wall Fractures in an East Asian Population

Background The objective of this article is to evaluate clinical outcomes of combined orbital floor and medial wall fracture repair using a three-dimensional pre-bent titanium implant in an East Asian population. Methods Clinical and radiologic data were analyzed for 11 patients with concomitant orbital floor and medial wall fractures. A combined transcaruncular and inferior fornix approach with lateral canthotomy was used for the exposure of fractures. An appropriate three-dimensional preformed titanium implant was selected and inserted according to the characteristics of a given defect. Results Follow-up time ranged from 2 to 6 months (median, 4.07 months). All patients had a successful treatment outcome without any complications. Clinically significant enophthalmos was not observed after treatment. Conclusions Three-dimensional pre-bent titanium implants are appropriate for use in the East Asian population, with a high success rate of anatomic restoration of the orbital volume and prevention of enophthalmos in combined orbital floor and medial wall fracture cases