gms | German Medical Science

Objectives/Interrogation: Syndactyly reconstruction typically includes full thickness skin grafts for areas of skin deficit after finger separation. Skin grafting requires additional anesthesia time and has donor site morbidity. In 2014, Landi et al. reported favorable outcomes with the use of a hyaluronic acid (HA) scaffold for syndactyly reconstruction instead of skin grafts [1]. The purpose of this investigation was to assess our objective outcomes with HA scaffold use in syndactyly reconstruction.

Methods: All patients who were treated for syndactyly reconstruction with HA scaffold at our institution from 2015-2017 who had at least 1 year follow-up were included. 23 webs in 16 patients were identified including 11 patients with congenital syndactyly, 3 with symbrachydactyly, and 2 with amniotic constriction band. Average age at surgery was 39 months. There were 7 female patients and 5 webs were revisions. All webs were assessed with blinded clinical photos by two congenital hand surgeons. Outcome measures included web creep assessment (range 0-4), Vancouver Scar Scale (0 normal) to characterize scar appearance and a Visual Analogue Scale (VAS) for appearance and satisfaction (range 0-10).

Results: Web creep averaged 0.4, with 15 webs having no creep. Vancouver Scar Scale averaged 1.25 including 19 webs had normal vascularity, 16 with normal pigmentation, 12 with normal pliability and 14 with a flat scar. VAS assessment of appearance was 9 on both surgeon and parent assessment (range 5-10) and VAS for satisfaction averaged 9 (range 7 - 10). There were no post-operative complications.

Conclusions: HA scaffold instead of skin grafts is a reasonable option in syndactyly reconstruction. Our heterogeneous population revealed satisfactory outcomes for both surgeons and families. While no post-operative complications were noted, the maximum deficit able to be covered has not yet been determined.