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

Abstract

Background: Local flabs and skin grafts are conventional methods of repair congenital syndactyly. Skin grafting for syndactyly repair is time consuming, has the potential risks of scar contracture and web creep and the results obtained are not always as functional and aesthetic as desired. In this article, we describe a graft-less surgical technique for web reconstruction in the correction of congenital simple syndactyly by using the dorsal metacarpal double winged advancement flab for web reconstruction with primary closure. Patients and Methods:Between March 2016 and May 2017, 10 paediatric patients with 14 congenital simple sydactylies were reconstructed with the dorsal metacarpal double winged advancement flab. Complex syndactylies, Apert syndrome, Poland syndrome, traumatic and or post-burn syndactylies were excluded from the study. Operation time, intraoperative complications, early and late post-operative complications were followed-up clinically, and photographs were taken, including dorsal and volar views before and after the operation as well as at 2 month regular intervals for 1 year. The patient age ranged from 9 months to 48 months (median of 28.5 months). The minimum follow-up period was 12 months (range, 12-28 months; mean, 21.4 months).Results: The mean operation time was approximately 78 minutes (65-90min.) Soft tissue defects were closed primarily without skin grafting in all cases. All the flabs survived completely without early complications such as infection, vascular compromise or delayed healing. No occurrence of long-term complications including web creep, flexion contractures, angulation deformity, or abnormal scarring formation were found during the follow-up period. Cosmetical and functional satisfactory outcomes were achieved in all cases without secondary revision. Conclusion:The dorsal metacarpal double winged advancement flab is a graft-less solution for web spac reconstruction is non-tight congenital simple syndactyly.