gms | German Medical Science

Objectives/Interrogation: Web reconstruction in finger syndactyly using a hexagonal dorsal skin flap and a straight midline incision gives a good cosmetic and functional result with little need for skin grafts.

Methods: We developed an easy technique to be used in simple complete (SC), simple incomplete (SI) and complex (C) syndactyly separation without the need of skin graft.

In C and SC nailfold and fingertip reconstruction is done using a technique described by Buck-Gramcko [1]. Tourniquet is used. Rigorous defatting is done, preserving the digital neurovascular bundles. Wounds are closed with absorbable sutures. Soft dressing is applied for 2 weeks. Patients are discharged the same day (Figure 1 [Fig. 1]).

Follow-up (FU) was scheduled at 2 weeks, 6 months and 1 year. Scar treatment with silicone sheets/gloves was started at 3 weeks by our occupational therapist.

Parents' satisfaction of functional and cosmetic outcome was assessed at last FU using a VAS scale (0-100).

Results and Conclusions: 20 patients (16 male, 9 left, 5 bilateral) underwent 30 web reconstructions (16 SI, 8SC, 6C) using our technique at median 16 (11-43) months of age. The level of the web was at PIP in 11 and at DIP in 5 of the 16 children with SI. Skin graft taken from outside the incision site was required in 1 patient (C). None of the patients were lost to follow-up, mean 11 (4-43) months. Complications (excessive scar formation, infection, circulatory or sensory problem) occurred in 1 SC patient who developed a post-operative infection, and web creep at 6 months. Mean functional and cosmetic VAS scores were 95 (63-100) and 90 (45-100) (Figure 2 [Fig. 2]).

This new technique for simple and complex syndactyly yields a good cosmetic and functional result with little need for skin graft.