Parental explanation

The Scar Solution Natural Scar Removal

The Scar Solution By Sean Lowry

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A long and detailed discussion is held with the parents explaining the surgical options as well as alternatives if appropriate. This discussion may require several visits beginning shortly after birth until the child is of appropriate age for treatment. Some centers involve a therapist and child psychologist in the preoperative visits [32]. The final decision to proceed with a toe transfer in a child with a congenital difference of the hand rests with the parents.

The surgeon must thoroughly discuss the issues of function, appearance, and the potential complications of surgery. Often, the option of transferring a toe to the hand has not even been proposed to the parents. A few studies have evaluated the psychologic issues associated with toe-to-hand transfer. Bellew and Kay [33] studied 37 children with congenital or posttraumatic hand anomalies and found a high level of satisfaction with regard to the surgery in terms of function, cosmesis, donor site, psychosocial wellbeing, and the reactions to others. The most devastating complication, failure of the toe transfer, must be emphasized so that the parents understand the complexity of the procedure and the risk of losing a normal toe. A realistic evaluation of the potential function to be gained must be considered, because, in some cases, the gain may not justify the complex surgery and subsequent recovery and rehabilitation. Interestingly, Bradbury and coworkers [34,35] found that parents were more influenced by factors within the process, such as communication, than by concerns about technical outcome. Specialized psychologic counseling had an integral role in decision making. Children whose parents were poorly adjusted preoperatively had more problems postoperatively, whereas children whose parents who were less anxious and happier showed benefit postoperatively [34].

The child's parents can be introduced to other parents whose child has already been through toe transfer surgery to discuss the surgery and outcomes and to see for themselves the function and appearance of a toe transfer for a similar congenital difference. Photographs and videos of similar children can also be viewed by the parents if

Fig. 2. (A, B) Absence of the thumb, index, and middle fingers at the level of the proximal phalanges and the ring finger at the level of the middle phalanx in a 2-year-old girl. (C, D) Because there were abnormalities affecting both second toes as well as absence of the left great toe, only the right great toe was available for transfer. (E, F) A right trimmed great toe was harvested. (G, H) Appearance and function of the right great toe-to-thumb transfer 6 years postoperatively. (I) Appearance of the donor right foot with hypertrophic scarring of the dorsal incision.

Fig. 2. (A, B) Absence of the thumb, index, and middle fingers at the level of the proximal phalanges and the ring finger at the level of the middle phalanx in a 2-year-old girl. (C, D) Because there were abnormalities affecting both second toes as well as absence of the left great toe, only the right great toe was available for transfer. (E, F) A right trimmed great toe was harvested. (G, H) Appearance and function of the right great toe-to-thumb transfer 6 years postoperatively. (I) Appearance of the donor right foot with hypertrophic scarring of the dorsal incision.

a direct introduction or visit is not possible. Models can be fabricated by the therapists to simulate the toe transfer in its new position. The donor defect in the foot must also be considered. Most surgeons consider the deficit after a second toe transfer to be functionally and cosmetically minimal (see Fig. 3G) [32].

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