Dorsal Island Flap for Syndactyly Reconstruction: A Skin-Sparing Technique Associated With Reduced Web Creep

To evaluate the functional and aesthetic outcomes of syndactyly reconstruction using a dorsal island flap and to assess whether avoiding skin grafting is associated with a reduced incidence of web creep.

A retrospective observational cohort study was conducted including patients who underwent syndactyly release with web space reconstruction using a dorsal island flap based on dorsal-palmar arterial communications. Web creep was defined as distal migration of the reconstructed commissure ≥2 mm compared with its immediate postoperative position. Patients were divided into grafted and nongrafted groups. The primary outcome was the incidence of web creep. Secondary outcomes included flap viability, complications, and aesthetic appearance of the reconstructed web space. Statistical comparisons between groups were performed using Fisher exact test, with significance set at P < .05.

Twenty-six patients (30 extremities) were included. Skin grafting was required in 11 extremities (42.3%), whereas 19 (57.7%) were reconstructed without grafting. Web creep occurred in 4 of 11 grafted extremities (36.4%) and in none of the nongrafted cases (0%) (P = .022). No cases of flap necrosis or infection were observed. The dorsal island flap demonstrated consistent vascular reliability, with identification of communicating vessels between the palmar and dorsal arterial systems in all cases. Aesthetic outcomes were favorable, with preservation of a natural-appearing web space contour.

Syndactyly reconstruction using a dorsal island flap represents a reliable, skin-sparing technique. Avoiding skin grafting was associated with a significantly lower incidence of web creep and elimination of donor-site morbidity.

Therapeutic IV.