Single-stage reconstruction of congenital multi-finger syndactyly with contiguous cross-shaped advancement flaps.

Abstract

Purpose: The purpose of this paper is to report the techniques and results of contiguous dorsal cross-shaped advancement flaps for reconstruction of the three- or four-finger syndactyly in a single-stage operation for congenital syndactyly.

Methods: Thirty-five patients with multiple-finger syndactyly for web-space reconstruction using the contiguous dorsal cross-shaped advancement flaps in a single operation were retrospectively studied. The patients were treated between January 2019 and October 2022. There were 20 patients with Poland syndrome, nine with constriction ring sequence, and six with synpolydactyly. One patient had bilateral hands involved. Twenty-three hands had three-finger syndactyly, and 13 hands had four-finger syndactyly. The patients' ages ranged from 5 to 96 months, with an average age of 29.6 months. The contiguous dorsal cross-shaped flaps were advanced to reconstruct both web space and lateral walls of the bases of the conjoined fingers. Withey grading was used for postoperative evaluation of web creep of each reconstructed web. Scar hyperplasia was assessed using the Vancouver Scar Scale (VSS). Visual Analogue Scale (VAS) of 0 to 10 was applied to evaluate the subjective satisfaction of the parents with the overall appearance and function.

Results: In all cases the syndactyly was successfully released in a single operation. There were no perioperative complications such as finger necrosis, incision infection, or skin graft failure in this group. During a 12-to-58-month follow-up period, all the reconstructed web spaces exhibited satisfactory appearance, and there was no obvious web creep. The scars on the dorsal side of the hand were acceptable. Revision surgery was not needed in any patients. Web creep averaged 0.45, and the VSS score averaged 1.6. The average VAS score of appearance was 1.2, and that of function was 2.5.

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