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Surgical Correction for Pediatric Epiblepharon and Trichiasis

Surgical Correction for Pediatric Epiblepharon and Trichiasis

Published on: July 8, 2025

Syndactyly correction: an aesthetic reconstruction.

R M Jose¹, N Timoney, R Vidyadharan

¹Department of Plastic Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK. rajivemathew@yahoo.com

The Journal of Hand Surgery, European Volume

|March 19, 2010

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This study presents an improved surgical technique for syndactyly (webbed digits) reconstruction, utilizing a combination of flaps and grafts for better aesthetic outcomes and functional improvement. The method minimizes visible scarring and effectively addresses both simple and complex cases.

Area of Science:

Plastic Surgery
Hand Surgery
Pediatric Surgery

Background:

Traditional syndactyly (webbed digits) repair often results in visible dorsal scars or is limited to simple cases.
Existing graftless techniques have limitations in applicability for complex syndactyly.
There is a need for reconstructive techniques that improve aesthetic outcomes and hand function in syndactyly.

Purpose of the Study:

To describe and evaluate a novel surgical technique for syndactyly reconstruction.
To assess the efficacy and aesthetic outcomes of the combined flap and graft technique.
To compare the complication rates and long-term results with existing methods.

Main Methods:

A retrospective review of 102 patients undergoing 176 syndactyly web reconstructions.

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Utilized a combined technique involving a shaped palmar flap for web space creation, V-flaps and full-thickness skin grafts for lateral defects, and pulp flaps for nail folds.

Grafts were strategically placed on the radial and ulnar sides to minimize visibility.

Main Results:

Successful reconstruction of 221 webs in 102 patients, including 54 simple (53%) and 48 complex syndactyly cases.
Low complication rate of 6% (11 operations) and minimal web creep at 5% (12 web spaces).
Re-operation for web creep was required in only 3% (7 web spaces).

Conclusions:

The described combined flap and graft technique offers an effective and aesthetically pleasing solution for syndactyly reconstruction.
This method improves palmar skin span and hides grafts, leading to favorable outcomes in both simple and complex syndactyly.
The technique demonstrates a low incidence of complications and web creep, making it a valuable addition to surgical options for webbed digits.