The Use of an Hourglass Dorsal Advancement Flap Without Skin Graft for Congenital Syndactyly.

PURPOSE: To investigate the efficacy of congenital syndactyly correction with flexion crease and web space reconstruction using a dorsal hourglass-shaped flap without skin graft.

METHODS: We studied 116 syndactylies in 96 patients. Surgical strategy focused on flexion crease and web space reconstruction using an hourglass-shaped dorsal advancement flap. We assessed for flap necrosis, height and width of the webs according to the criterion of D'Arcangelo, and total active digital motion compared with the normal side. Scar formation was measured by the Vancouver Scar Scale score. We also administered a parent-based satisfactory questionnaire.

RESULTS: Mean follow-up was 4.2 years. All syndactylies could be corrected without skin grafts. Dorsal flap plasty facilitated the reconstruction of commissure with a slope of 45° in an hourglass shape. Two cases encountered partial flap loss but healed without surgical intervention. There were no recurrences. According to the criterion of D'Arcangelo, the height and width of 98 webs were good, 16 webs were fair, and 2 webs were poor. Mean total active motion of the index, middle, ring, and little fingers of the affected side was 160, 158, 153, and 150, respectively. Mean Vancouver Scar Scale score was 1.4. After surgery, all parents were satisfied with the appearance and function of the separated fingers.

CONCLUSIONS: Reconstruction of the flexion crease and web space simultaneously with an hourglass-shaped dorsal advancement flap can achieve good aesthetic and functional outcomes.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.