Single-Stage Reconstruction of Congenital Multifinger Syndactyly with Contiguous Cross-Shaped Advancement Flaps.

Abstract

Background: The authors report the techniques and results of contiguous dorsal cross-shaped advancement flaps for reconstruction of 3- or 4-finger syndactyly in a single-stage operation for congenital syndactyly.

Methods: Thirty-five patients with multiple-finger syndactyly who received webspace reconstruction using the contiguous dorsal cross-shaped advancement flaps in a single operation were retrospectively studied. The patients ranged in age from 5 to 96 months (average age, 29.6 months). The contiguous dorsal cross-shaped flaps were advanced to reconstruct both webspace and lateral walls of the bases of the conjoined fingers. Withey grading was used for postoperative evaluation of web creep. Scar hyperplasia was assessed using the Vancouver Scar Scale. A visual analog scale of 0 to 10 was applied to evaluate the subjective satisfaction of the parents.

Results: In all cases, the syndactyly was successfully released in a single operation. There were no perioperative complications in this group. During a 12- to 58-month follow-up period, all reconstructed webspaces exhibited satisfactory appearance, and there was no obvious web creep. The dorsal hand scars were acceptable. Revision surgery was not needed in any patient. The average web creep was 0.45, and the average Vancouver Scar Scale score was 1.6. The average visual analog scale score for appearance was 1.2, and that for function was 2.5.

Conclusions: Multiple syndactyly release in 1 stage is feasible and safe. The contiguous cross-shaped flaps can be used to reconstruct 2 or more webspaces simultaneously after releasing.

Clinical question/level of evidence: Therapeutic, IV.