Double-Wing Flap for Polysyndactyly of the Fifth Toe

The purpose of this study was to investigate the long-term clinical outcomes of the double-wing flap in the treatment of polysyndactyly of the fifth toe fused with the fourth toe.

Between January 2016 and November 2019, 31 feet (4 bilateral, 23 unilateral) with polysyndactyly of the fifth toe fused with the fourth toe (27 patients) undergoing surgery using the double-wing flap with a follow-up higher than 5 years were included consecutively and retrospectively. Postoperatively, the toe function, slope and height of the reconstructed web were assessed in all feet and the measurements of the 23 unilateral polysyndactyly were compared with the normal side. D'Arcangelo criterion was used to grade the quality of the toe webbing and Vancouver Scar Scale score describes the quality of scar in all patients.

The patients were followed up for 5.1 to 8.3 years, a mean of 6.2 years. Two patients (2 feet) experienced web creep as a long-term complication, while the remaining feet showed no significant complications such as flexion contractures, angulation deformity or clinically significant keloid formation. The toe abduction, the slope and height of the reconstructed web of the 23 unilateral polysyndactyly showed no statistically significant difference compared with the normal side. Based on D'Arcangelo's criterion, 23 webs were rated as good, 6 as fair, and 2 as poor. The median Vancouver Scar Scale score was [1 (1, 2)].

The technique is a simple, safe, and easily performed method, which does not require skin grafts. It could be an alternative in the treatment of polysyndactyly of the fifth toe fused with the fourth toe, especially in cases with high cosmetic priority.