New Simple Technique for Syndactyly Release

Abstract

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.

Surgical considerations for syndactyly of the hand in harlequin ichthyosis: a 5-year experience of sequential surgical treatment in a single patient

“…For otherwise normal patients, it is recommended that syndactyly release should be done from 3 to 24 months depending on the type and web space involved. Also, if the patient needs multiple surgeries, the timing has to be at least 3 months apart [9]. In our case, the patient was 6 years old when she was first examined in the outpatient department.…”

Graftless Syndactyly Release

“…Ever since the description of syndactyly release by Cronin 5 involving the use of dorsal and interdigitating flaps with skin grafts, most of the literature has centered around different designs of flaps. 1,6,7,13 More recently, several of these variations were designed to avoid skin grafts, 1,7,13 which was seen as a good and attractive strategy for reasons already mentioned. However, caution must be taken against the indiscriminate use of a graftless technique, for example, when there is uncertain anatomy and the risk of web creep with an inadequate design.…”

“…Ever since the description of syndactyly release by Cronin 5 involving the use of dorsal and interdigitating flaps with skin grafts, most of the literature has centered around different designs of flaps 1,6,7,13 . More recently, several of these variations were designed to avoid skin grafts, 1,7,13 which was seen as a good and attractive strategy for reasons already mentioned.…”

Recent Advancements in the Diagnosis and Treatment of Congenital Hand Differences

“…Various approaches to syndactyly reconstruction have been introduced, with more recent innovations in skin-graftless techniques to avoid additional donor sites, decrease surgical times, and avoid complications associated with fullthickness skin grafting, including hypertrophic scarring and web creep (Table 2, Figure 3). [17][18][19][20] In addition, synthetic dermal substitutes may also be used to avoid full-thickness skin grafting. 16 Wall et al 16 conducted syndactyly releases using dorsally based commissural flaps with zigzag incisions and then used Hyalomatrix PA (Medline Industries), a bilayered skin substitute comprising benzyl ester and hyaluronic acid covered by a semipermeable silicone membrane, to cover remaining bare areas that then heal secondarily.…”