Treatment of Apert hand syndrome: Strategies for achieving a 5-digit hand

Background: Apert hand reconstruction requires complex surgical planning. The purpose of this study is to describe our 8 year surgical experience with Apert syndrome hand reconstruction, and provide specific surgical strategies for achieving a 5-digit hand in Upton type I and II hands. Methods: A retrospective analysis of consecutive Apert patients who underwent web space releases between 2007 and 2015 was performed. Demographic, surgical, and outcome data were verified through medical records, clinical photographs, radiographic images, and patient interviews. Results: A total of 41 Apert patients (23 [56.1%] male and 18 [43.9%] female) were treated at our Hospital since 2007. A 5-digit hand was achieved in all patients (100%) with Upton type I and II hands, and in 8 patients (72.7%) with Upton type III hands. A 4-digit hand was obtained in 3 of 11 patients (27.3%) with Upton type III hands. Four (25%) of 20 patients with Upton type I hands, 3 (30%) of 10 patients with Upton type II hands, and 6 (54.5%) of 11 patients with Upton type III hands, required subsequent revision for aesthetic reasons. Conclusion: Upton type III hands have demonstrated higher revision rates than type I and II hands, regardless of whether a 4 or 5-digit hand is obtained. Treatment strategies for Apert hands based on hand type are offered to guide 4-web-space release in all patients with Upton type I and II hands. Funding: None Conflict of interest: The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article. Corresponding author: Cassio Eduardo Raposo-Amaral, MD, PhD, Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil. E-mail: cassioraposo@hotmail.com ©2018American Society of Plastic Surgeons