Advantages of open treatment for syndactyly of the foot: Defining its indications

Abstract

For the repair of syndactyly of the foot, skin grafting is often used to close the skin defect, but open treatment is not common. However, with grafting, an additional scar at the donor site and patchwork-like scar at the recipient site are inevitable. Our aim was to describe the process of epithelialisation and define the indications for open treatment of syndactyly of the foot. The open treatment was used on 16 webs. The texture of epithelialised surface resembled volar skin; the visible scar was mainly at the dorsal edge; and web creep occurred predominantly on the volar side and resembled the natural slope of the commissure. Open treatment is better than skin grafting because of better match of texture without a patchwork-like scar, and it is indicated in cases of simple incomplete syndactyly of the foot that extends proximal to the distal interphalangeal joint.

The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment

“…Multiple techniques have been developed that use various flap designs with or without skin grafts to treat syndactyly. [ 7 , 8 ] The long-term aims of surgery include reduction in scarring both in the web and in the dorsum of the hand, avoidance of web space narrowing or web creep, and separation of the digits without using skin grafts. [ 10 , 11 ] The trilobed flap technique, or a dorsal triangular flap, or a dorsal rectangular flap, or a combination of interdigitating dorsal and volar triangular flaps may be used to treat syndactyly to reconstruct the web.…”

“…Recently, some authors have started using new techniques to reconstruct the web space and resurface the fingers without skin grafts. [ 7 , 8 ] The main differences of these techniques are the design of the web flap and the type of incisions used to separate the fingers. Although these techniques can obtain good results, these techniques need to be specially designed, as recurrences with more serious scars are common.…”

The Double Volar Flap Technique for Aesthetic Repair of Syndactyly and Polysyndactyly of Toe without Skin Grafting

“…However, the risk of web creep may be increased because of wound scar constriction, and the risk of infection is increased due to open wounds and Kirschner wire insertion in the toe until new epithelialization occurs to prevent contracture and the wound could be well taken care of by the parents at home during the 5 weeks of healing. 6 …”

Foot Syndactyly: A Clinical and Demographic Analysis

“…Recently, various techniques that do not require the application of skin grafts, such as open treatment, primary closure by defatting [78], or intricate local flaps [910], have been reported. These techniques are advantageous in that they shorten the operation time and minimize donor site morbidity.…”