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      Popliteal Pterygium Syndrome: A Case Report Highlighting Challenges and Surgical Interventions in a Resource-limited Setting

      case-report
      , MD * , , , MD, PhD, FCS-ECSA, FACS * , , MD, FCS-ECSA , , MD , , MD §
      Plastic and Reconstructive Surgery Global Open
      Lippincott Williams & Wilkins

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          Summary:

          Popliteal pterygium syndrome is a rare congenital disorder characterized by facial, genitourinary, and musculoskeletal anomalies, with popliteal webbing being notably challenging. A 4-year-old boy presented with progressive limping, cleft palate, and genital malformations. He had no follow-up care after an intraoral band excision at 15 days old. The boy underwent surgery for left-sided popliteal webbing, followed by genital and cleft palate repair. A modified jumping man Z-plasty flap was used for the popliteal webbing, followed by splinting. Subsequent follow-ups showed no complications. Enhancing care in resource-constrained settings requires addressing challenges such as delayed interventions due to late follow-up, limited awareness between communities and healthcare professionals, social stigma, and inadequate healthcare understanding. These obstacles hinder timely diagnosis and intervention, underscoring the need for increased awareness and effective early intervention strategies. Early detection and parental counseling are critical in managing popliteal pterygium syndrome. Timely surgical planning, including addressing orofacial and genital deformities and using Z-plasty for webbing release, is essential. Postoperative splinting significantly improves outcomes.

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          Most cited references10

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          Wounds morphologic assessment: application and reproducibility of a virtual measuring system, pilot study

          Background and Aims. Assessment of wounds morphology can be considered, in the everyday medical activity, the first step for the correct pathway of diagnosis. Authors present a pilot study focused on the statistical analysis of 32 cases of wounds measurements conducted by both the traditional method (paper ruler) both the digital smartphone analysis. Materials and Methods. 32 lesions were morphologically evaluated. All the enrolled patients were evaluated by both the traditional method (paper ruler) both a digital smartphone analysis based on the app imitoMeasure © . The extracted data were compared to the traditional measurements and a statistical analysis was based on intraclass correlation coefficients (ICC). Results. Three morphological parameters were evaluated: width (expressed in cm), length (expressed in cm) and area (expressed in cm 2 ). The area (expressed in cm 2 ) was found to be the less comparable, but the data were close in this case, too. Conclusion. The present study shows that the digital measuring systems should be easily addressed as versatile tools that could be applied in daily clinical practice in the future. (www.actabiomedica.it)
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            Novel IRF6 mutations in families with Van Der Woude syndrome and popliteal pterygium syndrome from sub-Saharan Africa

            Orofacial clefts (OFC) are complex genetic traits that are often classified as syndromic or nonsyndromic clefts. Currently, there are over 500 types of syndromic clefts in the Online Mendelian Inheritance in Man (OMIM) database, of which Van der Woude syndrome (VWS) is one of the most common (accounting for 2% of all OFC). Popliteal pterygium syndrome (PPS) is considered to be a more severe form of VWS. Mutations in the IRF6 gene have been reported worldwide to cause VWS and PPS. Here, we report studies of families with VWS and PPS in sub-Saharan Africa. We screened the DNA of eight families with VWS and one family with PPS from Nigeria and Ethiopia by Sanger sequencing of the most commonly affected exons in IRF6 (exons 3, 4, 7, and 9). For the VWS families, we found a novel nonsense variant in exon 4 (p.Lys66X), a novel splice-site variant in exon 4 (p.Pro126Pro), a novel missense variant in exon 4 (p.Phe230Leu), a previously reported splice-site variant in exon 7 that changes the acceptor splice site, and a known missense variant in exon 7 (p.Leu251Pro). A previously known missense variant was found in exon 4 (p.Arg84His) in the PPS family. All the mutations segregate in the families. Our data confirm the presence of IRF6-related VWS and PPS in sub-Saharan Africa and highlights the importance of screening for novel mutations in known genes when studying diverse global populations. This is important for counseling and prenatal diagnosis for high-risk families.
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              Popliteal pterygium syndrome: a clinical study of three families and report of linkage to the Van der Woude syndrome locus on 1q32.

              Popliteal pterygium syndrome (PPS) is a rare autosomal dominant disorder, thought to occur with an incidence of approximately 1 in 300 000 live births. The main clinical manifestations are popliteal webbing, cleft lip, cleft palate, lower lip pits, syndactyly, and genital and nail anomalies. This report describes the clinical features in two families with PPS and one isolated case, showing the range of anomalies found both within and between the families. PPS has some features in common with Van der Woude syndrome (VWS), also inherited as an autosomal dominant condition, with cleft lip/palate and, more distinctively, lower lip pits. Although the gene for VWS has not yet been identified, it has been localised to within 1.6 cM in the region 1q32-41. To determine whether PPS and VWS represent allelic forms of the same gene, three families were genotyped for markers flanking and within the critical region. A multipoint lod score of 2.7 was obtained, with no evidence of recombination, supporting the hypothesis that these two disorders are allelic.

                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2169-7574
                November 2024
                21 November 2024
                : 12
                : 11
                : e6332
                Affiliations
                From the [* ]Plastic and Reconstructive Surgery Department, Addis Ababa University, Addis Ababa, Ethiopia
                []Plastic and Reconstructive Surgery Department, Haramaya University, Dire Dawa, Ethiopia
                []Surgery Department, Wachamo University, Nigist Elleni Mohammed Memorial Hospital, Hosanna; Ethiopia
                [§ ]Orthopedics Surgery Department, Wallaga University, Nekemte; Ethiopia.
                Author notes
                Nagasa Wirtu Shanko, MD, Department of Plastic and Reconstructive Surgery, College of Health Science, Addis Ababa University, Addis Ababa 1000, Ethiopia, E-mail: sweetnws@ 123456gmail.com
                Article
                GOX-D-24-00544 00051
                10.1097/GOX.0000000000006332
                11581754
                39574490
                0171270b-b25e-4ff5-a835-bf1ad4ac6905
                Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 21 May 2024
                : 2 October 2024
                Categories
                Craniofacial/Pediatric
                Case Report
                Custom metadata
                TRUE
                ETHIOPIA

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