Dorsal Pentagonal Local Flap: A New Technique of Web Reconstruction for Syndactyly Without Skin Graft

Abstract

The dorsal pentagonal advancement flap is a dependable flap based on known perforators from the dorsal metacarpal arteries. The reported technique is a simple and effective technique for the correction of simple syndactyly and is especially suitable for reconstruction of two webs in multiple syndactyly simultaneously, avoiding the need for skin grafts and leaving acceptable scars on the dorsum of the hand for web reconstruction.

The Use of an Hourglass Dorsal Advancement Flap Without Skin Graft for Congenital Syndactyly

“…Defatting of the fingers and the interdigital space was performed to facilitate closure without skin graft, which may reduce recurrence and web creep. 7,9,10,16,18 Although defatting may lead to a thin finger, we observed no conspicuous change in finger contour compared with the non-syndactylized fingers in our cases. This may be because of the early separation age and good tissue regeneration capacity in children.…”

“…After that, a variety of dorsal flaps have been described to repair syndactyly without skin grafts. 2,7,9,17,18 The transfer of external flaps from the dorsum of the hand has been a major component of efforts made toward a skin graftefree reconstruction. Such methods may not achieve an aesthetic web because the resulting web configuration lacks of an hourglass shape and dorsopalmar inclination.…”

“…4 There are multiple techniques to reconstruct the web space: dorsal triangular flap, 5 dorsally based rectangular flap, 6 modified V-Y dorsal metacarpal flap, 7 combined interdigitating dorsal and palmar triangular flaps, 8 and dorsal pentagonallocal flap. 9 However, most of these flaps cannot reconstruct an hourglass-shaped web and require skin grafts to cover the resultant defects on the base of separated fingers or the lateral sides of the web. Consequently, scar contracture or web creep can occur.…”

Congenital Anomalies of the Upper Extremity

“…The procedure is based upon a local fl ap to recre-ate the web commissure, whilst lateral fi nger defects are closed directly. Modifi cations of this design include the use of a transposition fl ap [ 171 ], a V-Y advancement fl ap originating from a distal subcutaneous pedicle [ 172 ] and more recently a local dorsal pentagonal fl ap based on perforators from the dorsal metacarpal artery [ 173 ]. Although reliable in terms of resurfacing, these methods are associated with aesthetically displeasing scarring on the dorsum of the hand, which could potentially be avoided using other methods.…”

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

“…Introduced are a dorsal triangular flap [5,6], dorsally based rectangular flap, and a combination of interdigitating dorsal and palmar triangular flaps Many authors have used the dorsal arterial network of the hand to provide skin flaps allowing skin graft-free reconstruction [10][11][12], including dorsal hexagonal advancement flap, pentagonal local flap and tri-lobed advancement flap. They allow primary closure of the skin defects without skin graft [13][14][15].…”