Mendenhall Shaun D, Graham Emily M, Belardo Zoe E, Buttrick Eliza, Card Elizabeth B, Shah Apurva S, Chang Benjamin
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Spencer Fox Eccles School of Medicine at the University of Utah and Intermountain Primary Children's Hospital.
Section of Plastic Surgery, Department of Surgery, University of Michigan.
Plast Reconstr Surg. 2025 Jun 1;155(6):969-981. doi: 10.1097/PRS.0000000000011925. Epub 2024 Dec 17.
Simple syndactyly is a common congenital upper extremity difference. Traditional reconstructive approaches use skin grafts; however, recent studies suggest that skin graftless techniques may improve outcomes. The authors hypothesized that patients who underwent reconstruction with a skin graftless dorsal metacarpal island VY advancement flap would have fewer postoperative complications compared with those released with a dorsal rectangular flap with skin grafts.
Patients aged 0 to 17 years presenting for primary reconstruction of simple syndactyly were analyzed retrospectively at a large pediatric hospital. Medical records were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes, CPT codes, and case logs from 6 hand surgeons. Outcomes of interest included early postoperative complications (within 30 days) such as infection, hematoma, seroma, wound healing issues, unplanned returns to the operating room, and digit loss. Late complications (>30 days) included web creep and development of pathologic scar formation.
In total, 213 syndactyly repairs from 153 patients were analyzed (rectangular, 94 webspaces and 58 patients; VY, 119 webspaces and 95 patients). The rectangular group had significantly more early complications ( P = 0.04). The rectangular group had significantly higher incidences of web creep and hypertrophic scarring (19.3% versus 1.8%, P < 0.001; 19.1% versus 5.9%, P = 0.003, respectively). The rectangular flap with skin grafts was the only variable predictive of web creep and hypertrophic scar formation on regression analysis ( P < 0.001 and P = 0.004, respectively). Subgroup analyses of syndromic and nonsyndromic cases and incomplete and complete cases mirrored overall cohort results.
Simple syndactyly releases with the skin graftless technique produces fewer complications compared with the traditional approach with skin grafts.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
