Keloid formation after congenital toe syndactyly release is associated with preoperative toe hypertrophy: A retrospective observational clinical study.

Abstract

Keloids that form after the division of congenital toe syndactyly are rare and difficult to treat, and their etiology is unknown. In this retrospective study, we investigated the correlation between postoperative keloid development and preoperative hypertrophy of the toe syndactyly and made preliminary recommendations for perioperative therapy. Twenty-six patients with hypertrophic toe syndactyly (hypertrophy group) and 26 non-hypertrophic patients (control group) were enrolled between 2014 and 2022. All patients were treated by the same surgeon for syndactyly division and postoperative scar management. The occurrence of keloids between and within groups after surgery was analyzed, with P < 0.05 considered statistically significant. A total of 55 toes in 26 patients underwent syndactyly separation in the hypertrophy group, 51 of which were hypertrophic and developed keloids postoperatively. The other 4 toes were non-hypertrophic and did not develop keloids, and the difference was statistically significant (P < 0.05). In the hypertrophy group, 12 patients had keloid resolution after anti-scar treatment, 3 were discontinued after ineffective treatment, one received distal phalangeal amputation due to keloid recurrence, and 10 were untreated and keloid formation was noted during follow-up. There were no keloids in 26 cases in the control group, which was significantly different from all 26 keloids in the hypertrophy group (P < 0.05). Keloid formation in congenital toe syndactyly release is significantly associated with preoperative toe hypertrophy. A full-thickness skin graft to break the overlap of hypertrophic tissue on either side of the incision during surgery is essential to minimize keloid formation.