Correction of Syndactyly Using a Dorsal Separated V-Y Advancement Flap and a Volar Triangular Flap in Adults

Abstract

Skin grafts and local flaps are conventional methods of repair for congenital syndactyly, but the results obtained are not always as functional and aesthetic as desired and frequently leave postoperative scars and residual syndactyly. In this article, we describe a new surgical technique for web reconstruction in the correction of simple, incomplete syndactyly. The technique consists of a dorsal separated V-Y advancement flap and a volar triangular flap to cover the newly created web space, thus avoiding skin graft in this space. In all, 15 web spaces in 10 patients were treated using this method. A follow-up period of 6 months to 2 years showed neither recurrence of the deformity nor web creep of any degree. The technique is rapid, safe, easily performed, and reproducible and requires a single surgical procedure. It uses donor tissue identical in color, texture, and thickness, which renders acceptable cosmesis in cases of simple, incomplete syndactyly, therefore, avoiding the use of skin grafts and resulting postoperative scar contracture in the web space.

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

“…27,34,39,40 ). In several articles reporting on skin graft techniques, scar quality was described by subjective statements such as "acceptable," 17,43 "inconspicuous," 11,43 or "satisfactory." 33 Only 1 of the 4 publications that reported hypertrophic scarring in the skin graft group employed a graded scale.…”

Syndactyly Release

“…30,31 Since then, a myriad of graft-free techniques has been described (►Table 2). [30][31][32][33][34][35][36][37][38][39][40][41][42] No single technique has been identified as a gold standard for surgical correction. However, the most common techniques involve a pedicled dorsal metacarpal artery flap that receives numerous small contributory vessels.…”

The Dorsal Metacarpal Double Winged Advancement Flap: A Skin Graft Free Technique for Web Reconstruction in Congenital Simple

“…Excessive skin on the dorsum of the hand can be easily advanced distally as a perforator pedicled flap and form a new web space with matching texture, thickness and color, this flap can be well perfused by the underlying fascia pedicle and dorsal metacarpal artery [24]. Ekerot [25] reported a technique using a dorsal flap from the syndactylized proximal phalanges to substitute commissural skin grafts.…”

“…An island V-Y advancement flap based on the direct cutaneous branch of the dorsal metacarpal artery, facilitating a graft-free web reconstruction in syndactyly, has been reported [24]. Subsequently, use of the dorsal metacarpal artery flap as an elliptical transposition flap for web reconstruction has been developed [28].…”