The Modified 3-square Flap Method for Reconstruction of Toe Syndactyly

Area of Science:

• Plastic Surgery
• Pediatric Surgery
• Hand Surgery

Background:

• Syndactyly, a congenital fusion of digits, often requires surgical correction.
• Existing methods like the 3-square-flap may have limitations for specific toe syndactyly cases.
• Fusion distal to the proximal interphalangeal joint presents unique reconstructive challenges.

Purpose of the Study:

• To present a modified 4-flap technique for reconstructing toe syndactyly.
• To evaluate the efficacy and safety of this modified flap design for distal interphalangeal joint fusion.
• To assess outcomes regarding flap viability, scar contracture, and functional results.

Main Methods:

• A modified 4-flap (A-D) design was employed for interdigital space reconstruction.
• Flaps A, B, and C were raised with a thin dermal-subdermal layer, while flap D maintained a thick subcutaneous pedicle.
• Specific suturing techniques were used, avoiding contact between certain flap pairs to prevent complications.

Main Results:

• Eight patients with toe syndactyly distal to the proximal interphalangeal joint were treated between 2011 and 2015.
• No instances of flap ischemia or necrosis were observed postoperatively.
• The reconstructed interdigital spaces maintained adequate depth without scar contracture, and no revision surgeries were needed.

Conclusions:

• The modified 4-flap technique is a safe and effective procedure for toe syndactyly involving fusion distal to the proximal interphalangeal joint.
• This method provides durable reconstruction, preventing common complications and ensuring satisfactory aesthetic and functional outcomes.
• The technique is suitable for early surgical intervention in congenital syndactyly cases.