Correction of syndactyly without skin grafts is simple and reliable. Combined with an absorbable suture technique the non-grafting method is further advantageous minimising risks and saving time and costs. Three methods are compared: skin grafts plus monofilament polyamide (Ethilon, Ethicon) (n = 32), no skin grafts plus Ethilon (n = 19), and no skin grafts plus polyglactin 910 (Vicryl rapide, Ethicon) (n = 9). The two groups in which grafting was not used had significantly shorter operations (mean 86 minutes compared with 118 minutes) and fewer complications. They also required fewer operations and spent less time in hospital.

In a series of 48 painfully restricted wrists denervation was used during a 6-year period on wide indications as a surgical alternative. The observation time averaged 2.4 years. Pain relief occurred in 56% of the patients. Considering the simplicity of the method and the lack of serious complications, it is concluded that denervation of the wrist is worth trying as a palliative measure prior to more extensive surgery.

A rare case of total palmar trans-scaphoid-lunate dislocation is reported. Open reduction, bone grafting and internal fixation were followed by uneventful healing. At follow-up 70 months after injury there is no osteonecrosis and the wrist function is almost normal.

Syndactyly correction results in skin deficiency. Skin grafting is avoided by the use of an extended dorsal interdigital flap for the web and approximation of the side flaps to cover the length of the digits. The technique has been used in 17 cases with all varieties of syndactyly. There were no early complications. The follow-up averaged 2 years. There were two cases of web creep but no contractures. The method combines the advantage of direct suture with an acceptable frequency of web creep.