Measured Flap Planning for Adult Complex Syndactyly Release: A Technical Case Report

Adult untreated complex syndactyly is a rare clinical presentation and may pose a unique set of reconstructive challenges due to long-standing tissue adaptation. Various flap designs for syndactyly release are described, but pre-operative planning of the flaps is often based on visual estimation and surgeon experience. We report a systematic measurement-based flap planning technique (MFPT) in the reconstruction of complex syndactyly in an adult patient.

A 23-year-old male presented with an untreated complex congenital syndactyly of the middle and ring fingers with functional limitation and esthetic concerns. The clinical examination showed fusion to the fingertips with confluent nail plates with no evident involvement of the nail folds. Radiographs showed soft-tissue syndactyly with bony fusion of the distal ends of the distal phalanges. Pre-operative planning included identification of the anatomical landmarks, determination of a central dorsal axis, evaluation of the digital width, marking of the corresponding zig-zag flaps, planning of the web commissure and verification of the flap symmetry prior to incision. These markings were used to guide surgical dissection and soft-tissue reconstruction, sparing the digital neurovascular bundles and nail beds. Post-operative radiographs demonstrated separation of the previously fused distal phalanges.

Current techniques for syndactyly release are primarily based on flap design and web space reconstruction, with pre-incision planning possibly remaining subjective to surgeon judgment. MFPT provides a systematic sequence in the translation of anatomical landmarks, digital width evaluation, flap correspondence, web- apex positioning and symmetry verification to the pre-operative marking process. In this situation, the technique was feasible as a planning aid to standard syndactyly reconstruction. Its reproducibility and potential advantages over conventional planning need to be evaluated in larger prospective studies with pre-defined geometric and functional outcome measures.

MFPT is a structured, measurement-based protocol for pre-operative planning of flaps in adult complex syndactyly. This allowed for systematic flap marking and subsequent reconstruction. Future studies should assess its reproducibility, clinical utility, and potential advantages over traditional experience-based flap planning.