Congenital syndactyly: defatting facilitates closure without skin graft

We attempted to correct 24 syndactylies without skin grafts in 16 consecutive patients. Digital volume was decreased by defatting the full length of the fingers and the interdigital space. Closure of the zigzag incisions on both fingers could then be achieved with minimal tension and did not seem to be related to the type of flap used for commissure resurfacing. We used 2 different types of flap closure. We noted that defatting was a more important determinant of whether the wound could be closed without graft than flap configuration. The new type of flap may represent an improvement for web appearance but is not a determination for finger closure. Only a complex syndactyly involving 3 adjacent atrophied fingers required a skin graft for separation. The results were evaluated after a mean follow-up period of 22 months. Three patients had a complication: an intraoperative digital nerve laceration, a scar contracture, and a recurrence of the treated commissure due to local infection. Two patients needed another surgical procedure. Supple and good quality scars were observed in the other patients. No conspicuous change in finger contour compared with the nonsyndactylized fingers was observed.