New Simple Technique for Syndactyly Release

Abstract

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.

Fig. 1.

Grading of web creep according to Withey et al. Grade 0: soft web, abduction mirrors the adjacent web or equivalent web on the other hand. Grade 1: no web advancement, but thickening of the web with reduced span. Grade 2: creep of web to 1/3 of the distance between base of the web and PIPJ crease. Grade 3: creep of web to 2/3 of the distance between base of the web and PIPJ crease. Grade 4: creep of web to the PIPJ crease. PIPJ indicates proximal interphalangeal joint.

Fig. 2.

Surgical incisions and site for skin graft. The specific geometric measures for the dorsal hexagonal skin flap are based on the interspace of the knuckles of the fingers to be separated: the distance measured between the midpoints of the knuckles is the same as the height of the flap as well as the distal width (BC). AD = 2 × BC. *Can be used as a skin graft.

Fig. 3.

Defatting and skin closure. A, Hexagonal flap raised and dorsal defatting. B and C, Defatting from volar side and removal of the excess fat in one piece dorsally. D–F, Wound closure with absorbable sutures.

Fig. 4.

Patient 1: simple incomplete syndactyly 3 years after surgery. A, View from dorsal side. B, View from palmar side.

Fig. 5.

Patient 5: simple complete syndactyly 2 years after surgery. A, View from dorsal side. B, View from palmar side.

Fig. 6.

Patient 22: complex (right hand) and complicated (left hand) syndactyly 6 months after surgery. A, View from dorsal side. B, View from palmar side.

Fig. 7.

Patient 25, complicated (right hand) and SI PIP (left hand) syndactyly six months after first surgery (A and B). Same patient three weeks after second surgery (C and D). The last separation is not included in our results as the follow-up is too short.