Background: Over the past few decades in a trial to avoid
skin grafting and its drawbacks in syndactyly repair, graftless
techniques of syndactyly release were advocated with promising
success. Two principles typically underly those techniques:
Importation of more dorsal hand skin by appropriate
flap design and/or finger defatting, this permitted web space
reconstruction with direct closure of the fingers. In the present
study, a graftless syndactyly repair technique using dorsal
VY advancement flap for web space reconstruction combined
with defatting of the separated digits is investigated.
Patients and Methods: The technique was used in repair
of 15 syndactylized web spaces (10 simple incomplete & 5
simple complete syndactyly) in 7 cases, aged between 12-24
month at first surgery. Dorsal VY advancement flap from the
hand dorsum just proximal to the neo web space was advanced
to resurface the web based on the dorsal intermetacarpal artery
perforator. Fingers were separated by straight line incision
bisecting the fused digits, this was closed directly after carful
finger defatting, resulting in straight line midlateral finger
scar.
Results: The technique achieved adequate web space
without the need for skin graft in all operated cases. Neither
flap necrosis nor web creep was seen in this series with
average of 14 months follow up. Midlateral finger scars were
cosmetically and functionally accepted. No finger contracture
was noticed. Flap donor site (dorsal hand) scar was less
forgiving with average of 5 out of 10 on VAS score assessment.
Conclusion: The technique is simple and reliable for
repair of simple syndactyly without the need of a skin graft.
It is easy to perform in relatively short time.