Surgical treatment of polydactyly and syndactyly during the 4th century AD.

INTRODUCTION: Polydactyly, or polydactylism, is a common congenital disorder of the limbs, consisting of any digit duplication beyond the normal five. The term syndactyly refers to fused digits. We herein present a thorough description of these diseases together with their surgical treatment, provided by Oribasius, a Byzantine physician of the 4th century. To our knowledge, this is the earliest description of supernumerary and fused fingers and their surgical management. MATERIAL AND METHODS: We conducted a thorough study of Oribasius' work. RESULTS: The 15th chapter of the 47th book of Oribasius' work is devoted to finger abnormalities (i.e. polydactyly and syndactyly) and their surgical treatment. DISCUSSION: With regard to the extensive medical knowledge of the 4th century as survived in Oribasius' work, these descriptions comprise, to the best of our knowledge, the earliest written references to the surgical treatment of polydactyly and syndactyly.

Vital endowments: Sir Charles Bell and the history of some congenital abnormalities of the upper limb.

Born in Edinburgh in 1774 Sir Charles Bell, as a young man, studied anatomy and surgery in his hometown. There followed a distinguished career that culminated in his becoming the first professor of Anatomy and Surgery at the College of Surgeons in London. Renowned as a brilliant neuroanatomist he was invited, on the advice of His Grace the Archbishop of Canterbury and the Bishop of London, to contribute one of eight volumes of a work on the Power Wisdom and Goodness of God as manifested in the Creation - known as the Bridgewater Treatises. 'The Hand its Mechanism and Vital Endowments as Evincing Design' was published in 1833 and it is an account of his considering the hand as a machine that has been engineered to exacting standards to interact with the environment in which we live. In it he expressed a deep understanding of the similarity of the structure of the upper limbs of the higher orders of animals. The similarity of the paddle of a turtle and a human hand with acrosymbrachydactyly is unmistakable. This congenital abnormality, given the eponymous title of Apert's syndrome, is one of a number of congenital abnormalities that have parallels in the animal kingdom. Others who have had similar syndromes named after them include Poland, Marfan, Streeter and a number of others. The life and times of these men and their contributions to medicine will be presented in this paper.

Dividing the fingers in congenital syndactyly release: a review of more than 200 years of surgical treatment.

In three specific eras the approach to the dividing of the fingers in syndactyly release has changed. In the 19th century "straight cutting" or local flaps were used; then in the beginning of the 20th century skin grafts were introduced. After Cronin published work on zigzag incisions, combinations of zigzag incisions, flaps, and grafts came into use. Here, we present a review of the most important technique, given in a historical perspective.