Treatment of congenital syndactyly with rectangular flaps

Abstract

Congenital sydactyly is a very frequent hand affection. The surgical procedure usually requires a dorsal flap to reconstitute the web space and the release of the fingers using some wavy line to avoid straight line contracture. The techniques mostly used present a high success rate but there are some difficulties related to the handling of small flaps. Besides, there is a need for several skin grafts which if not perfectly taken results in functional and cosmetic sequelae. We developed a design of rectangular flaps that, in our hands, have made the procedure technically simpler and obviated the need of skin grafts on the fingers. Skin grafts are used only at the sides of the new web space. Twenty-four patients with ages from one to twenty-five (average = 4 years) had their syndactylies (total) operated on. Sixteen were unilateral and eight bilateral. Thirty-two hands were thus treated. The results were assessed according to the criteria: 1) adequate web; 2) number and quality of skin grafts on the fingers; 3) hypertrophy of the scars and cosmetic appearance. Using these criteria 19 results (59.3%) were assessed good, 12 (37.6%) fair and only one, poor result (3.1%). Compared with other techniques this one presents a simpler planning of flaps, provides an adequate web space and few skin grafts are required on the fingers.