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Syndactyly is most common congenital anomaly of hand. Incidence of congenital syndactyly is 1 in 2000 to 1 in 3000 life births. Syndactyly may be congenital or acquired. Syndactyly may be acquired, occurred following burns or trauma. Surgical Management of syndactyly should be properly planned for aesthetically and functional hand postoperatively. The study was conducted in department of Plastic surgery, VIMSAR Burla, a tertiary centre in Western Odisha from July 2022 to December 2023. All types of syndactyly patients admitted were included in the study. In total 20 cases of syndactyly were included. All data about sex pattern, age group, aetiology, types, involvements of limbs, web space involvement and different complications following procedure was collected. Males were more commonly affected, with male female ratio 1.1:0.9. Most common age group was more than 20 years. Most of the syndactyly was congenital (75%). Hand was most commonly involved than foot. Bilateral involvement was common in hand and foot than unilateral involvement. In hand 3rd web space was most commonly involved (62.5%) and in foot 2nd web space most commonly involved (54.54%). Most common complication was hypertrophic scar in 17.14% of web operated. In none case neurovascular injury occurred. Good aesthetic functional hand can be achieved with proper planning and proper tissue handling during syndactyly surgery. Awareness among patients must be done for early surgical intervention in syndactyly [ABSTRACT FROM AUTHOR]

Background The first web space of the hand plays a crucial role in determining the hand's span. Our study aims to examine and quantify the first web space angle in both hands of adult individuals within the Indian population with no upper limb pathologies. The primary objective of this study is to establish normative data. These data will be useful in surgical correction for the first web release, recommending corrective splints, and calculating the percentage of disability in hand function.

Background The first web space of the hand plays a crucial role in determining the hand's span. Our study aims to examine and quantify the first web space angle in both hands of adult individuals within the Indian population with no upper limb pathologies. The primary objective of this study is to establish normative data. These data will be useful in surgical correction for the first web release, recommending corrective splints, and calculating the percentage of disability in hand function. Materials and Methods Data from 800 individuals from various regions across India, ranging in age from 20 to 50 years who had no pathology in both upper limbs were collected. A goniometer was used to measure the first web space angle of both hands by keeping the forearm pronated, elbow flexed, and arms adducted. The subjects from different states were divided into various zones. Results In 800 subjects, the average measurement in the right hand was 97.28 degrees, and in the left hand, 99.76 degrees. In males, the average measurement in the right hand was 97.54 degrees, and in the left hand, it was 99.61 degrees. In females, in the right hand, it was 96.93 degrees, and in the left hand 100 degrees. The result was recorded in subjects from each zone in the country. Conclusion The large sample size from various parts of the country makes the study more reliable. The technique of measuring the angles was easily reproducible. Our findings provide crucial normative data for clinicians and therapists. [ABSTRACT FROM AUTHOR]

Polysyndactyly of the foot is a common congenital malformation of the lower extremity. We introduce our surgical technique for reconstruction of polysyndactyly of the fifth toe fused with the fourth toe. The technique includes the removal of the medial hypoplastic ray, web-space reconstruction using a dorsal cross-shaped advancement flap and closure of the lateral incisions of the separated toes with a tongue-shaped flap and zigzag triangular flaps. This technique is advantageous to prevent postoperative web creep, reduce the tension of the dorsal incision closure and it is relatively easy to grasp for the inexperienced surgeon. Level of Evidence: Level V (Therapeutic).

Electronic commerce has affected all aspects of life; it results from technological development and is still in progress. This development has some consequences and results for people. Breach of personal data and privacy is one of them. Cyberspace has targeted all aspects of personal data such as genetic, identity, physiological, behavioral, and religious beliefs information to achieve their political, economic, and social goals. This article aims to assess the legal protection of privacy in accordance with GDPR and Iranian laws. That is, whether these rules can prevent the violation of privacy on the Web, or whether in the digital age, it is the end of privacy and personal data protection. It is a significant issue that requires careful analysis and evaluation. In this paper, by examining the concept of privacy in EU regulations and the Iranian legal system, it is analyzed that laws need to be more up-to-date than developments in the digital age. The concept of privacy and personal data must be specifically introduced and protected within the law. To be placed. However, none of the domestic legal systems examined laws have a comprehensive and coherent definition of personal data, and this gap should be addressed in Iranian law. Finally, a broad definition of personal data is provided.

Calcifying aponeurotic fibromais an uncommon, benign fibroblastic tumor which has a preference for neighborhood invasion and a high relapse rate. Henceforth, precise preoperative analysis and complete extraction are imperative to counteract the recurrence of the tumor after careful surgical removal. We report a case of 75 year old man with left hand first web space calcified aponeurotic fibroma with distinct radiological and MRI features.

In the modern world, technogenic visual communication becomes an integral part of the life of society, the complexity of the technological basis of which has generated new forms of visual imagery. The relevance of the problem is due to the increasing role of the phenomenon of visuality in the formation of social and cultural foundations of modern social practices, including the use of innovative information and communication platforms of the Internet environment. Thanks to computer technologies, the mechanisms of creating visual images are changing, which affects the established forms of social communication and necessitates the study of new codes of visual images, changing processes of perception and understanding of visual forms of expression of social meanings. The subject of the research in the article is the forms of visuality in the Internet environment, the purpose is to identify the communicative specificity of visual technogenic forms and their functions in the Internet environment. It is argued that along with the inherent functions of social communication information, socialization, social integration of Internet communication due to the increasing share of visual communication and contains dysfunctional manifestations.

Background: There are several congenital hand differences that cause thumb-index (TI) web space deficiency. There is a knowledge gap in the literature about the hand differences that are associated with TI web space deficiency. We aimed to identify these congenital differences and the various specific reconstructive surgical procedures that are used for these conditions. Methods: We conducted a retrospective chart review of children treated operatively over a period of 30 years for congenital TI web space deficiency by the senior author (G.M.R.). We gathered data on demographics and associated congenital hand differences and compiled a list of all surgical procedures performed for the web space and the ipsilateral upper extremity. Results: We included 71 patients (77 hands) with 12 congenital hand differences (62 developmental and 9 spastic). The total number of upper extremity operations, (ie), anesthetics performed for these patients was 186, averaging 2.6 settings and 7.5 procedures for each patient. Cutaneous reconstructive procedures included first dorsal metacarpal artery pedicle flaps (49 patients), 4-flap Z-plasties (15), and transposition flaps (13). In addition, 16 different thumb reconstructive procedures were necessary. Ten patients required revision of their TI web space procedures for recurrence. Conclusions: The prevalence of TI web space deficiency is underappreciated. These patients often have multiple musculoskeletal anomalies of the hand and upper extremity that should be ruled out and require surgical treatment to optimize hand function. Consideration should be given to performing more than one procedure in one setting when possible. [ABSTRACT FROM AUTHOR]

One hundred and sixty patients were enrolled in a prospective randomized controlled trial to assess whether a steroid injection through the dorsal web space was less painful than the palmar midline technique in the treatment of trigger digits and whether they were equally effective. There were 116 women and 44 men with a mean age of 60 years. The mean visual analogue score for pain during the injection was 3.6 in the dorsal web space group and 5.4 in the palmar midline group on a scale of 0–10. The overall success of treatment in the dorsal group was 67%, whereas it was 56% in the palmar group. No complications were noted. We concluded from this study that the dorsal web space technique is less painful and at least as effective as the palmar midline technique. Level of evidence: I [ABSTRACT FROM AUTHOR]

The differences in the anatomy of the foot and the hand may affect the dorsal flap design for web space reconstruction. In this study, the authors aimed to identify the differences in web space anatomy of the foot and the hand and provide a guideline of flap design for web space reconstruction in the foot and the hand. The right hands and right feet of adult volunteers were measured, including surgical landmarks (i.e., the dorsal prominence of proximal interphalangeal and metacarpophalangeal joints [or metatarsophalangeal joints]), proximal phalangeal length, tip of the web space, and width of web space. The web spaces and other parameters were analyzed and compared between the foot and the hand by using a paired t test with p <.05 to indicate statistical significance. A total of 108 web spaces of the foot and hand from 18 adult volunteers were analyzed. The parameters that were significantly different between the foot and the hand included (1) proximal phalangeal length (34.63 vs 60.16 mm), (2) average web height ratio (0.72 vs 0.51), (3) average web width ratio (0.69 vs 0.81), (4) mean slope angle (4.89° vs 19.26°), and (5) average abduction angle (25.33° vs 31.07°). In conclusion, the foot web space had a higher slope angle, less abduction angle, and shorter proximal phalangeal length. Therefore, the flap design for foot web space reconstruction requires a longer and narrower flap than the design for the hand. The recommended flap design length should be at least 72% of proximal phalangeal length for the foot versus 51% for the hand, and the width should be at least 69% of the distance between the tips of adjacent metatarsophalangeal joints for the foot versus 81% for the hand. [ABSTRACT FROM AUTHOR]

We studied anomalies of the common digital arteries by dissecting 33 fresh cadaver hands under magnification. In the majority of the dissected hands (25 hands), common digital arteries took off from the superficial palmar arch and ran superficial and parallel to the flexor tendons. Variations were found in eight out of 33 hands. In four hands the common digital artery to the second web space was replaced by an atypical vessel, originating from the deep palmar arch, that crossed posterior to the index flexor tendons proximal to the A1 pulley. In eight hands, the common digital artery to the fourth web space was replaced by an atypical deeper vessel, originating from the superficial palmar arch and crossing posterior to the little finger flexors. No nerve anomalies were identified. Unrecognized, these atypical arteries to the second and/or fourth web spaces could lead to vascular complications during surgery, especially pollicization. [ABSTRACT FROM AUTHOR]

The reconstruction of oral commissure, lip and mucosa defects following tumour resection is a challenging task to the reconstructive surgeon owing to the increasing aesthetic and functional demands. The authors describe a case in which the use of combined first-second toe web with dorsalis pedis flap was transferred and an optimal result was achieved for the oral commissure, lip and buccal mucosa following resection of squamous cell carcinoma and local flap failure. [ABSTRACT FROM AUTHOR]

Syndactyly is usually corrected surgically during the first years of life. The trilobed flap, a surgical method that does not require skin grafting, was developed in the 1990s and the short-term results were comparable with previously reported techniques. Here we report on long-term outcomes, focusing on how children perceive their hand function and quality of life when they grow up. A total of 19 patients (29 web spaces) were operated on between 1990 and 2000, and followed-up 16 years later with questionnaires and clinical tests. The patients reported low QuickDASH scores, normal sensibility and dexterity, and minor cold intolerance. Only two reoperations, due to early web creep, were needed. The condition minimally affected the choice of occupations, leisure activities and perceptions of appearance. The trilobed flap technique for release of syndactyly provides a good long-term outcome with good hand function and minimal impact on the quality of life.Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose To describe the technique and results of the tapered M-to-V flap for syndactyly web space construction. Methods We reviewed a single-surgeon, single-institution experience of all syndactyly reconstructions performed between 1982 and 2013. Demographic data and patient characteristics were recorded. Complications included flap loss, graft loss, web creep, infection, restricted range of motion, and digit deviation. Results A total of 138 web spaces were reconstructed in 93 patients. There were 89 primary congenital hand and 32 foot syndactylies. Four patients had an acquired simple incomplete syndactyly and 13 patients had secondary reconstructions. The complication rate was 14%. The most common complication was web creep resulting from partial skin graft loss (12 web spaces; 9%). There were no total flap losses. Univariate analysis revealed no factor to be predictive of an elevated complication rate. Average follow-up was 2.6 years (range, 6 mo to 26 y). Conclusions The tapered M-to-V flap proved to be a reliable and versatile technique for web space reconstruction, offering several advantages over the standard rectangular flap method of repair, such as ease of intraoperative adjustment, a z-plasty at the palmodigital crease to minimize scar contracture, and better color match. Type of study/level of evidence Therapeutic IV. [ABSTRACT FROM AUTHOR]

Each component of the web space, a three-dimensional structure, should be carefully created during reconstruction of web space loss. One of these web space components is the web height. In this study, the dorsal view of subjects' hands was analyzed to determine the web height ratios. The web height ratios were then compared with respect to age and sex. The second and third web height ratios differed between adult men and women and between children and adults. However, no differences were observed among children. This study is unique because it focuses on the web height ratios of all web spaces according to age and sex and provides a very easy-to-use scale that may help surgeons to perform web space reconstruction. Moreover, the present study adds to the literature by providing information on the first web height ratios of the hand. [ABSTRACT FROM AUTHOR]

Background Web space contractures after a burn can cause severe impairments in hand function along with esthetic deformities. In this study we present our experience with the combined treatment technique consisted of rhomboid flap and double Z-plasty for palmar and dorsal web space contractures. Materials and methods Combined rhomboid flap and double Z-plasty was performed in eight patients with eleven web space contractures occurred after burn. The average follow-up was 10.9 months. Results The average age of 8 patients was 16.3 years. The average duration of burn contractures was 6 years (range 1–13 years). The right third web of the patients was the most common contracted web space. In the postoperative period hematoma, infection, partial or total flap loss was not observed in any patient. Web and hand function and esthetic appearance of web spaces were satisfactory in the late postoperative period. Conclusion Rhomboid flap combined with a double Z-plasty technique was an effective choice for the treatment of palmar and dorsal web space contracture after burn. [ABSTRACT FROM AUTHOR]

The creation of the normal web spaces has been attributed to apoptosis. This paper presents evidence that lysosomal-mediated cell death and extracellular matrix degradation are important events in addition to cell death by apoptosis. The author proposes the use of the term interdigital cell death– extracellular matrix degradation instead of interdigital apoptosis. Furthermore, the concept of web creation by differential growth is introduced along with the discussion of the latest research in molecular biology and genetics on the topic. [ABSTRACT FROM PUBLISHER]

Background: Severe postburn web space contracture is a major challenge to the plastic surgeon. Surgical release and skin grafting are frequently associated with contracture recurrence (web creep). Methods: In an attempt to prevent web space contracture recurrence after surgical release and skin grafting, a special traction device was fabricated and used postoperatively after skin grafting in 11 patients (31 web spaces). The patients were observed for web creep and development of complications for 6 to 15 months. Results: From a total of 31 web spaces, recurrence occurred in 7 web spaces only, and the cause of recurrence in 3 of them was pressure necrosis of the skin graft due to excessive traction; the recurrence in the other 4 webs was due to inconsistent adherence to the traction regimen. Conclusion: The web space traction device is a new, easily made, well tolerated, and effective way to prevent web creep formation following skin grafting. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Summary: Cleft foot deformity is characterized by the absence of one or more median rays of the foot. This rare polymorphous congenital anomaly occurs more frequently in males, with a frequent autosomal dominant type of transmission. The purpose of surgical treatment is to narrow the width of the foot, but also to improve its global aesthetic look. Toe reparation, and more specifically web space reconstruction, provide the main technical challenges. We present an adaptation to the foot of a laterodigital cutaneous flap published by Barsky in 1964 for commissural reconstruction in cleft hand syndroms. The anatomical structure of fingers and toes commisures being different, this flap seems more adapted to the surgery of the foot. We gathered seven patients’ files treated for ectrodactyly of the foot with this technique by the same surgeon from 2005 to 2008. No particular postoperative complications were noted, and the patients all expressed their satisfaction regarding the improvement of the appearance of their foot. We recommend to add the use of this flap in the “tool box” of the surgeon in charge of the management of foot deformities. [ABSTRACT FROM AUTHOR]

The Web initially emerged as an 'antidote' to accumulated scientific knowledge, since it enables global representation and communication at a minimum cost. Its gigantic scale and interdependence allow us our ability to find relevant information and develop trustworthy contexts. It is time for science to compensate by providing an epistemological 'antidote' to Web issues. Philosophy should be in the front line by forming the salient questions and analysis. We need a theory about Web being that will bridge philosophical thinking and engineering. This article analyzes existence and spatiotemporality in the Web and how it transforms the traditional actualities. The resulting issues concern the self-determination of a being and the way in which the Web could be a free and open platform for innovation and participation. [ABSTRACT FROM AUTHOR]

Abstract: Various local connectedness and compactness properties of topological spaces are characterized by higher degrees of distributivity for their lattices of open (or closed) sets, and conversely. For example, those topological spaces for which not only the lattice of open sets but also that of closed sets is a frame, are described by the existence of web neighborhood bases, where webs are certain specific path-connected sets. Such spaces are called web spaces. The even better linked wide web spaces are characterized by -distributivity of their topologies, and the worldwide web spaces (or C-spaces) by complete distributivity of their topologies. Similarly, strongly locally connected spaces and locally hypercompact spaces are characterized by suitable infinite distributive laws. The web space concepts are also viewed as natural extensions of spaces that are semilattices with respect to the specialization order and have continuous (unary, binary or infinitary) semilattice operations. [Copyright &y& Elsevier]

This paper presents a modification of the technique described by Yao et al. using a vascular island flap based on a dorsal digital vessel, which allows transfer of the web proximally and retains the integrity of the web skin. The technique was used in nine patients, aged from 1 to 15 years at operation, with nine incomplete simple syndactylies. The results were assessed at a mean of 36 (range 5–60) months after surgery. No vascular compromise or web creep was noted. This technique enables transfer of web skin proximally in cases of simple, incomplete syndactyly, avoids the presence of scars in the web space and does not require skin grafts. [ABSTRACT FROM PUBLISHER]

Web space reconstruction is the key point and an important component of syndactyly treatment. A design of the dorsal metacarpal artery flap was used as an island flap based on the direct cutaneous branch arising from the dorsal metacarpal artery at the distal end of the flap to reconstruct congenital web syndactyly. The flap rotated from 0° to 180° and passed under a skin bridge at the distal end of the flap to reach the web defect. Such design enables a better use of the skin territory from the intermetacarpal space proximal to the pedicle, with a short donor site scar and a more supple reconstruction of the web space. [Copyright &y& Elsevier]

Although Dupuytren’s disease of the thumb was first described in 1833, the literature on this subject is limited to a few anatomical and clinical studies. This study examined the pattern of cords of Dupuytren’s disease in 260 thumbs in 181 consecutive patients with evidence of disease relating to the thumb attending an out-patient clinic over a period of 36 months. Discrepancies in the literature are discussed in the light of the findings of this more detailed analysis and a simple but practical pictorial system for recording disease severity and detailing progression over time is presented. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: The authors evaluate their results of congenital syndactyly correction using a classic commisural dorsal flap technique and full thickness skin grafts to cover the lateral and medial aspect of the fingers. Material and method: It is a retrospective study on a homogeneous series of 38 children (54 simple syndactylies) operated over a 10-year period. Twenty-two children were included with a mean follow-up of five years and 10 months. Results: This technique is reliable, reproducible, with a low rate of complications (only four complications requiring reoperation). Long-term outcomes are satisfactory in 92% of cases. Conclusion: This is an effective technique, restoring the natural shape of the web space. Procedures without skin-graft are less time-consuming in terms of operational time and cosmetically acceptable, but still need to prove their worth. [Copyright &y& Elsevier]

Oncologic defects of the hand can be problematic for the reconstructive surgeon. These defects may require a delay in definitive coverage until clear margins of resection can be obtained, which can result in a prolonged period of painful dressing changes and increased risk of soft-tissue infection. In addition, reconstructive options for oncologic defects are often limited to skin grafting, which can yield functional deficits secondary to contracted healing. Currently, there is no definitive method for preventing skin graft contracture; however, acellular dermis has been proposed as a biomechanical scaffold to enhance subsequent skin graft healing and slow this functionally debilitating process. Here, we present a patient with recurrent melanoma of the first dorsal web space. After re-resection of the melanoma, the 11 cm × 5 cm defect was reconstructed using acellular dermis as temporary coverage to allow ample time for permanent section results. Ten days later, after confirming negative margins of resection, a split-thickness skin graft (STSG) was applied over the vascularized neo-dermis. Follow-up clinical examination and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires were used to assess outcome. At 7 months, the patient had no recurrence of melanoma and a DASH functional reduction of only 6.9%. After approximately 18 months, the patient’s wounds had healed with excellent cosmetic and functional results, without any evidence of a web space contracture. These observations suggest that acellular dermis is a useful adjunct for wound coverage of the hand, particularly in areas of functional importance, such as the first dorsal web space. [ABSTRACT FROM AUTHOR]

The release of postburn contractures in the hand is one of the most commonly performed procedures in burn injuries. Contractures of the web space may involve palmar, dorsal, or both sides of the web skin and require various surgical techniques. In this report we provide general guidelines for the release of these contractures, with special emphasis on reconstruction of the second through fourth web spaces. [Copyright &y& Elsevier]