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Limb Dysdifferentiation

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Congenital Deformities of the Hand and Upper Limb

Part of the book series: Plastic and Reconstructive Surgery ((PRS))

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Abstract

Syndactylia is the fusion between the adjacent interdigital soft tissues and skeletons to varying extents, which is induced by the failure in a certain stage during the normal finger (toe) separation and formation of fingerweb. During normal development [1], fingers are formed during the mesoderm differentiation inside the terminal hand plates of the upper limbs during the embryonic phase. The formation of finger interdigital space is an apoptosis-regulating process; the direction is from far to near until the normal fingerweb is reached [2]. This process depends on the molecular signal of apical ectodermal ridge and multiple cytokines, including bone morphogenetic protein, transforming growth factor β, fibroblast growth factor, and tretinoin [3–7]. The normal second, third, and fourth fingerwebs have an inclination of 45° from the dorsal side to the volar side, a sand clocklike structure from the head of metacarpal bone to the middle point level of proximal phalanx, added to the proximal digital transverse striation (Fig. 6.1). The second and the fourth fingerwebs are wider than the third fingerweb, which makes the index finger and the little finger have a larger degree of abduction. The first fingerweb is a piece of broad rhombic skin, consisting of volar hairless skin and the skin with a large range of motion at the dorsal side which is relatively thin.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Wei Wang & Bin Wang

  2. The First Affiliated Hospital, Zhejiang University, Hangzhou, China

    Jinghong Xu, Jialiang Chen & Yizhen Chen

  3. Hangzhou City First People’s Hospital, Hangzhou, China

    Zhenyu Bian, Wangxiang Yao & Liulong Zhu

  4. Hangzhou Plastic Surgery Hospital, Hangzhou, China

    Jianmin Yao, Biwei Zeng, Longchun Zhang & Sheng Ding

  5. Jilin University First Hospital, Changchun, China

    Xu Gong & Laijin Lu

  6. Qingdao city Municipal Hospital, Qingdao, China

    Yunfei Zhang

  7. Xi’an Honghui Hospital, Xi’an, China

    Hongxing Zhang

  8. Shanghai Ninth People Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Shengbo Zhou, Yongkang Jiang & Feng Ni

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    Wei Wang

  2. Hangzhou Plastic Surgery Hospital, Hangzhou, China

    Jianmin Yao

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Wang, W. et al. (2017). Limb Dysdifferentiation. In: Wang, W., Yao, J. (eds) Congenital Deformities of the Hand and Upper Limb. Plastic and Reconstructive Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-10-5101-2_6

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