A Systematic Review and Comparison of Outcomes Following Simple Syndactyly Reconstruction With Skin Grafts or a Dorsal Metacarpal Advancement Flap

Sullivan, Matthew; Adkinson, Joshua M.

doi:10.1016/j.jhsa.2016.11.006

Cited by 38 publications

(32 citation statements)

References 40 publications

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“…Performing an objective assessment of scar quality after surgery can be challenging. Many researchers have only reported ‘acceptable’ (Ekerot, 1999) scar quality and ‘good cosmesis’ (De Smet et al., 1998), which are difficult to interpret and compare (Sullivan and Adkinson, 2017). Although various scar scales are available, only a few studies of syndactyly have made use of them (Lumenta et al., 2010; Sulser et al., 2016; Widerberg et al., 2016).…”

Section: Discussionmentioning

confidence: 99%

“…When comparing skin graft techniques to graft-less techniques, the latter have been found to cause fewer complications and prevent the need for additional procedures (Magdi Sherif, 1998; Sullivan and Adkinson, 2017; Sykes and Percival, 1989). Sullivan and Adkinson (2017) performed a systematic review comparing complications and results between skin grafts and the dorsal metacarpal advancement flap. They found a significantly higher incidence of web creep in the skin graft group ( p ≤ 0.05).…”

Section: Introductionmentioning

confidence: 99%

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A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction?

Ferrari

Werker

2018

J Hand Surg Eur Vol

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Syndactyly correction without skin grafting is advocated because it prevents graft-related complications and donor site morbidity. In this cross-sectional study, we compared satisfaction among patients who underwent correction with and without skin grafting to determine preference based on subjective and objective parameters. Retrospective chart analysis was performed among 27 patients (49 webs) who were seen at follow-up after a median follow-up period of 7.4 years, at which the Patient and Observer Scar Assessment Scale, the Withey score and a satisfaction survey were used. Notably, there were no significant differences in complication rates or observer rated scar scores. Although the need for an additional surgical procedure was higher after skin grafting, patient-rated satisfaction scores were similar irrespective of the use of grafting. Our data suggest that corrections can best be performed without skin grafts if seeking to minimize the need for an additional procedure, but that the use of skin grafts does not appear to affect patient satisfaction. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction?

Ferrari

Werker

2018

J Hand Surg Eur Vol

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“…Web creep is the most common complication after syndactyly release usually appearing within 3 years after surgery, with a reported incidence of up to 60%. 3 , 14 , 28 Postoperative infections and partial skin graft loss can lead to web creep, in which risk appears to vary also between different web reconstruction techniques. 25 , 27 , 28 Age at the time of surgery does not seem to correlate with the risk of web creep, 25 , 27 which seems to be similar in patients treated with (4%–30%) or without (3%–24%) skin grafts.…”

Section: Discussionmentioning

confidence: 99%

New Simple Technique for Syndactyly Release

Grahn

Nietosvaara

Sommarhem

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Can good functional and cosmetic result be achieved in syndactyly separation using a straight midline incision with a hexagonal dorsal skin flap? Methods: We performed 39 web reconstructions at a median of 20 months of age (11–43 months) to 26 consecutive children (21 male) with 30 simple, 4 complex, and 5 complicated syndactylies. Eighteen of the simple syndactylies were incomplete, ending at the proximal interphalangeal joint in 15 and at the distal interphalangeal joint in 3. Inguinal skin grafts were used in 2 children with either complex or complicated syndactyly. Operation time was recorded. Complications were registered. Height of the new web spaces was calculated. Parents’ satisfaction on both functional and cosmetic outcome was assessed using a Visual Analog Scale from 0 to 100. Results: Duration of one web reconstruction ranged from 50 to 95 minutes in simple incomplete, 56 to 135 in simple complete, 116 to 151 in complex, and 72 to 123 in complicated syndactylies. One child had a self-induced bilateral postoperative infection that lead to web creep. Two patients developed hypertrophic scars, which responded well to silicone treatment. Mean cosmetic and functional Visual Analog Scale scores were 87 (45–100) and 92 (63–100), respectively, at a mean follow-up of 1.3 years (range, 0.5–3.7). Conclusion: Web reconstruction using a hexagonal dorsal skin flap and straight midline incisions with closure at mid-lateral lines is safe, with good cosmetic and functional outcome in our short-term follow-up.

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“…[13] Previous studies have shown that skin grafts increase the risk of web creep by exerting tension across the web space, particularly when the graft abuts either the dorsal commissure flap or palmar scar junction. [12] Of the surgical techniques reviewed, those described by Matsumine et al [11] in 2011, Hsu et al [14] in 2010 and Yamashita et al [8] in 2016 do not require the use of a skin graft for the flap donor site.…”

Section: Discussionmentioning

confidence: 99%

Resolution of 2nd, 3rd or 4th interdigital space incomplete, simple syndactyly using a random vascularity flap

Llave¹,

Murat²,

Figueroa³

2017

PAR

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A Systematic Review and Comparison of Outcomes Following Simple Syndactyly Reconstruction With Skin Grafts or a Dorsal Metacarpal Advancement Flap

Abstract: Therapeutic IV.

Cited by 38 publications

References 40 publications

A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction?

A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction?

New Simple Technique for Syndactyly Release

Resolution of 2nd, 3rd or 4th interdigital space incomplete, simple syndactyly using a random vascularity flap

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