Hourglass Dorsal Metacarpal Island Flap: A New Design for Syndactylized Web Reconstruction

Results of syndactyly release using a modification of the Flatt technique

“…The suggestion that web creep is associated with skin grafting, and in particular secondary healing from skin-graft loss, has encouraged the use of graft-less techniques in syndactyly surgery. However papers describing graft-less techniques frequently involve small numbers, with short follow-up periods (usually less than 2 to 3 years) or more than one surgeon involved in the primary surgery (Aboul Wafa, 2008; Sharma et al, 2009; Sherif, 1998). Only two papers reporting graft-less techniques could be identified as having a sufficient number of cases, long enough follow-up, or having been performed with acceptable rigor to be compared with this series.…”

“…There has been a trend towards ‘graft-less’ techniques designed to overcome complications associated with skin grafting including hyperpigmentation, hirsute grafts, and graft failure. Even in the absence of graft failure, proponents of graft-less techniques suggest that skin grafts increase the risk of web creep by virtue of reduced intrinsic growth potential (Niranjan et al, 2005; Niranjan and De Carpentier, 1990), increased risk of contraction (Aboul Wafa, 2008; Sharma et al, 2009), and hypertrophic scarring on the borders of skin grafts (Sherif, 1998; Toledo and Ger, 1979).…”

Aesthetic Comparison of Two Different Types of Web-Space Reconstruction for Finger Syndactyly

“…4 Several variations of local skin flaps have been described for syndactyly web space reconstruction, including the dorsal rectangular flap, dorsal triangular flap, or the interdigitating V-flap, among others. 3,5-10 However, these procedures require skin grafting to the resultant defect and donor scars. Modifications of flap design, such as with the dorsal pentagonal advancement flap, incorporate more dorsal skin and thus, do not require a skin graft and, ultimately, decrease surgical time.…”