Purpose
Interdigitating triangular flaps is the most commonly described technique for syndactyly
release. However, triangular flaps may be associated with flap misalignment, flap
tip necrosis, and a steep learning curve in design and technique. This study describes
a series of syndactyly reconstructions using interdigitating rectangular flaps in
both simple and complex syndactyly.
Methods
A single surgeon’s experience of syndactyly reconstruction using interdigitating rectangular
flaps was reviewed retrospectively. Patient demographics, associated syndromes, operative
technique, complications, and recurrences were analyzed.
Results
Ninety-four web spaces in 50 children with 16 simple incomplete, 36 simple complete,
14 complex, 26 complicated, and 2 unclassified syndactylies were reconstructed with
interdigitating rectangular flaps. Seventy-eight commissures were reconstructed with
a dorsal pentagonal island flap and 16 with a dorsal rhomboid flap. Full-thickness
skin grafts were used in 98% of webs. Five major complications required surgical intervention—2
recurrences, 2 web space scarrings, and 1 wound infection. Ten minor complications
occurred—skin graft donor site dehiscence (3), partial loss of the skin graft (4),
minor distal interphalangeal joint flexion contractures (2), and a case of minor web
creep (1). Average follow-up was 13.7 months. All parents were satisfied with the
function and appearance of their child’s reconstructed digits.
Conclusions
Interdigitating rectangular flaps provide an effective technique for release of both
simple and complex syndactyly. Advantages include easy learning owing to the relative
simplicity of design; intraoperative modification of flap design (cut as you go),
and wide flap tips, which prevent flap tip necrosis.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Accepted:
January 25,
2019
Received:
December 21,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
