The pulp plasty: a composite graft for complete syndactyly fingertip separations

Area of Science:

• Plastic Surgery
• Hand Surgery
• Regenerative Medicine

Background:

• Syndactyly, a congenital condition involving webbed digits, often requires surgical separation and reconstruction.
• Complex syndactyly and synonychia present significant reconstructive challenges, particularly in fingertip coverage.
• Traditional grafting methods may not always provide optimal aesthetic and functional outcomes for fingertip defects.

Purpose of the Study:

• To evaluate the efficacy of composite skin and subcutaneous fat grafts from the foot for fingertip reconstruction after syndactyly release.
• To assess the graft take, aesthetic results, and functional outcomes of this reconstructive technique.
• To determine the suitability of this method for both simple and complex syndactyly cases.

Main Methods:

• Composite grafts of skin and subcutaneous fat were harvested from non-weight-bearing areas of the foot.
• Grafts were used to reconstruct 34 fingertips in 13 patients following the separation of 23 complete syndactyly webs.
• Patient follow-up averaged 13.9 months to assess outcomes.

Main Results:

• A 100% graft take was achieved in all 34 reconstructed fingertips.
• Subjective assessments indicated 94% good and 6% fair results, with no poor outcomes.
• The technique successfully addressed both simple (17%) and complex (83%) syndactylies, including cases with synonychia (70%).

Conclusions:

• Composite grafts from the foot are a highly effective method for fingertip reconstruction after syndactyly release.
• This technique provides a satisfactory contour and digital pad, leading to excellent patient outcomes.
• The procedure offers a reliable reconstructive option for complex hand deformities involving syndactyly.