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Operative techniques

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Operative techniques for correction of syndactyly need to address many potential problems:

  • options for recreation of web space include:
    • dorsal rectangular flap of thinner, more mobile skin tranposed into palmar defect(1):
      • commonly used
      • trapezoidal in shape
      • designed by measuring the length of neighbouring commissures and adding a few millimetres to this length to allow for minor adjustments
      • centered on the middle of the interdigital space of the syndactylised digits
      • typically 8-9 mm in width at base and narrower at tip
    • modification of this design with:
      • dorsal triangular skin flaps to aid in resufacing of dorsal sides of digits
      • making the tip of the rectangular flap oblique, diamond shaped or 'M'-shaped to fit into a 'Y'-shaped defect volarly
      • rectangular flaps from the volar side
    • transposition of opposing palmar and dorsal inverted-V triangular skin flaps
    • island flap method eg using a V-Y advancement of an island of dorsal skin into the commissure
    • dorsal four flap z-plasty
    • jumping man flap
    • historically as uniformly prone to poor results, simple division of skin or free skin grafting alone
  • separation of digits:
    • classically, achieved by interdigitating triangular skin flaps from the volar and dorsal surfaces of the digit(2):
      • typically, 60 degree angles at the tips of flaps with none crossing perpendicular to flexion creases
      • obliquity of scars reduces the risk of flexion contracture
      • usually not enough skin to resurface the sides of both digits and small full thickness skin grafts are placed into the gaps; grafts are usually harvested from the groin and inset under minimal tension; other options for donor sites include the medial malleolar area of the foot
    • other described options include:
      • simple longitudinal separation; prone to poor results but may be useful in the unusual situation of Apert's Syndrome where symphalangism prevents flexion contractures
      • tissue expansion dorsally to obviate the need for skin grafting
      • bone distraction away from the meridian of the web to create more skin prior to division
      • pedicled distant flaps for skin cover eg groin flap
  • recreation of nail fold: Buck-Gramcko technique with a flap of triangular pulp folded back onto the ipsilateral margin of the nail

 

 

Ref: (1) Bauer TB, Tondra JM, Trusler HM (1956). Plast Reconstr Surg; 17: 385-392. (2) Cronin TD (1956). Plast Reconst Surg; 18: 460-468.

 


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