Syndactyly correction: an aesthetic reconstruction

Various flaps have been used with and without skin grafts to separate digits with syndactyly. Dorsal flap techniques with and without grafts result in dorsal and thus more visible scars. Some of the recent techniques which use no grafts are only applicable for some simple syndactylies. The technique described in this paper uses a combination of techniques which have been described previously. A shaped palmar flap is used to create the web space; narrow V-flaps and full-thickness skin grafts are used to resurface the lateral defects on the fingers and reciprocal pulp flaps are used to create aesthetically pleasing nail folds. This technique allows the full thickness grafts to be hidden on the radial and ulnar sides of the fingers and palm. It increases the span of the hand in conditions where there is shortage of palmar skin. A retrospective review has been undertaken of 102 patients in whom 221 webs were reconstructed through 176 surgical procedures. There were 54 cases of simple syndactylies (53%) and the rest were complex. Complications were encountered in 11 operations (6%) and web creep was noted in 12 web spaces (5%). Re-operation for web creep has been carried out in seven web spaces (3%).