Editor's choice| Volume 44, ISSUE 4, P288-295, April 2019

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Interdigitating Rectangular Flaps and Dorsal Pentagonal Island Flap for Syndactyly Release

  • Alfred P. Yoon
    Section of Plastic and Reconstructive Surgery, University of Michigan Health System, Ann Arbor, MI
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  • Neil F. Jones
    Corresponding author: Neil F. Jones, MD, Department of Orthopedic Surgery, University of California Los Angeles, 1260 15th St., Santa Monica, CA 90404
    Department of Orthopedic Surgery and Department of Plastic and Reconstructive Surgery, Center for Hand and Upper Extremity Surgery, University of California, Irvine, Irvine, CA
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      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.


      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.


      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.


      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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