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Semin Plast Surg 2016; 30(04): 162-170
DOI: 10.1055/s-0036-1593478
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Syndactyly Release

Tara L. Braun
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
Jeffrey G. Trost
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
William C. Pederson
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
18 November 2016 (online)

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Abstract

Syndactyly is one of the most common congenital hand anomalies treated by pediatric plastic surgeons. Established principles of syndactyly separation dictate the timing and order of syndactyly release, with the goals of surgery being the creation of an anatomically normal webspace, tension-free closure of soft tissue, and return of function to the fingers. Numerous surgical methods have been described, many of which involve the use of local flaps to reconstruct the commissure and full-thickness skin grafts for coverage of raw areas. Recently, reconstructive techniques without the use of skin grafts have been devised, which work well for certain indications. Special considerations are described for complete, complex, and syndromic syndactylies. Outcomes for simple syndactyly release are typically good when surgical principles are followed, whereas complex syndactyly release tends to have less-favorable outcomes and more complications.

Keywords

syndactyly - congenital hand anomalies - skin graft - commissure reconstruction - web creep
 

  • References

  • 1 Green DP, Hotchkiss RN, Pederson WC, Wolfe SW. Green's Operative Hand Surgery. Vol. 2. 7th ed. Philadelphia, PA: Elsevier; 2017: 1217-1232
    Google Scholar
  • 2 Malik S. Syndactyly: phenotypes, genetics and current classification. Eur J Hum Genet 2012; 20 (8) 817-824
    CrossrefPubMedGoogle Scholar
  • 3 Netscher DT, Baumholtz MA. Treatment of congenital upper extremity problems. Plast Reconstr Surg 2007; 119 (5) 101e-129e
    CrossrefPubMedGoogle Scholar
  • 4 Kozin SH. Syndactyly. J Hand Surg Am 2001; 1: 1-13
    CrossrefPubMedGoogle Scholar
  • 5 Upton J. Congenital anomalies of the hand and forearm. In: McCarthy JG, May JW, Littler JW, , eds. Plastic Surgery: The Hand. Part 2. Vol. 8. Philadelphia, PA: WB Saunders; 1990: 5213-5398
    Google Scholar
  • 6 Man LX, Chang B. Maternal cigarette smoking during pregnancy increases the risk of having a child with a congenital digital anomaly. Plast Reconstr Surg 2006; 117 (1) 301-308
    CrossrefPubMedGoogle Scholar
  • 7 Luo JY, Fu CH, Yao KB, Hu RS, Du QY, Liu ZY. [A case-control study on genetic and environmental factors regarding polydactyly and syndactyly]. Zhonghua Liu Xing Bing Xue Za Zhi 2009; 30 (9) 903-906
    PubMedGoogle Scholar
  • 8 Kozin SH, Zlotolow DA. Common pediatric congenital conditions of the hand. Plast Reconstr Surg 2015; 136 (2) 241e-257e
    CrossrefPubMedGoogle Scholar
  • 9 Oda T, Pushman AG, Chung KC. Treatment of common congenital hand conditions. Plast Reconstr Surg 2010; 126 (3) 121e-133e
    CrossrefPubMedGoogle Scholar
  • 10 Hutchinson DT, Frenzen SW. Digital syndactyly release. Tech Hand Up Extrem Surg 2010; 14 (1) 33-37
    CrossrefPubMedGoogle Scholar
  • 11 Lumenta DB, Kitzinger HB, Beck H, Frey M. Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J Hand Surg Am 2010; 35 (8) 1323-1329
    CrossrefPubMedGoogle Scholar
  • 12 Jose RM, Timoney N, Vidyadharan R, Lester R. Syndactyly correction: an aesthetic reconstruction. J Hand Surg Eur Vol 2010; 35 (6) 446-450
    PubMedGoogle Scholar
  • 13 Goldfarb CA, Steffen JA, Stutz CM. Complex syndactyly: aesthetic and objective outcomes. J Hand Surg Am 2012; 37 (10) 2068-2073
    CrossrefPubMedGoogle Scholar
  • 14 Goldfarb CA. Congenital hand differences. J Hand Surg Am 2009; 34 (7) 1351-1356
    CrossrefPubMedGoogle Scholar
  • 15 D'Arcangelo M, Gilbert A, Pirrello R. Correction of syndactyly using a dorsal omega flap and two lateral and volar flaps. A long-term review. J Hand Surg [Br] 1996; 21 (3) 320-324
    CrossrefPubMedGoogle Scholar
  • 16 Shaw DT, Li CS, Richey DG, Nahigian SH. Interdigital butterfly flap in the hand (the double-opposing Z-plasty). J Bone Joint Surg Am 1973; 55 (8) 1677-1679
    PubMedGoogle Scholar
  • 17 Cronin TD. Syndactylism: results of zig-zag incision to prevent postoperative contracture. Plast Reconstr Surg (1946) 1956; 18 (6) 460-468
    CrossrefPubMedGoogle Scholar
  • 18 Killian JT, Neimkin RJ. Syndactyly reconstruction by a modified Cronin method. South Med J 1985; 78 (4) 414-418
    CrossrefPubMedGoogle Scholar
  • 19 Sawabe K, Suzuki Y, Suzuki S. Temporal skin grafts following straight incision for syndactyly correction. Ann Plast Surg 2005; 55 (2) 139-142 , discussion 143–145
    CrossrefPubMedGoogle Scholar
  • 20 Sharma RK, Tuli P, Makkar SS, Parashar A. End-of-skin grafts in syndactyly release: description of a new flap for web space resurfacing and primary closure of finger defects. Hand (NY) 2009; 4 (1) 29-34
    CrossrefPubMedGoogle Scholar
  • 21 Withey SJ, Kangesu T, Carver N, Sommerlad BC. The open finger technique for the release of syndactyly. J Hand Surg [Br] 2001; 26 (1) 4-7
    CrossrefPubMedGoogle Scholar
  • 22 Karacaoglan N, Velidedeoglu H, Ciçekçi B, Bozdogan N, Sahin U, Türkgüven Y. Reverse W-M plasty in the repair of congenital syndactyly: a new method. Br J Plast Surg 1993; 46 (4) 300-302
    CrossrefPubMedGoogle Scholar
  • 23 Lewis RC, Nordyke MD, Duncan KH. Web space reconstruction with a M-V flap. J Hand Surg Am 1988; 13 (1) 40-43
    PubMedGoogle Scholar
  • 24 Flatt A. The Care of Congenital Hand Anomalies. Vol. 2. London: Churchill Livingston; 1996: 228-275
    Google Scholar
  • 25 De Smet L, Van Ransbeeck H, Deneef G. Syndactyly release: results of the Flatt technique. Acta Orthop Belg 1998; 64 (3) 301-305
    PubMedGoogle Scholar
  • 26 Barabás AG, Pickford MA. Results of syndactyly release using a modification of the Flatt technique. J Hand Surg Eur Vol 2014; 39 (9) 984-988
    CrossrefPubMedGoogle Scholar
  • 27 Karamese M, Akdag O, Selimoglu MN, Unal Yıldıran G, Tosun Z. V-Y and rectangular flap combination for syndactyly repair. J Plast Surg Hand Surg 2016; 50 (2) 102-106
    CrossrefPubMedGoogle Scholar
  • 28 Deunk J, Nicolai JP, Hamburg SM. Long-term results of syndactyly correction: full-thickness versus split-thickness skin grafts. J Hand Surg [Br] 2003; 28 (2) 125-130
    CrossrefPubMedGoogle Scholar
  • 29 Ekerot L. Syndactyly correction without skin-grafting. J Hand Surg [Br] 1996; 21 (3) 330-337
    CrossrefPubMedGoogle Scholar
  • 30 Niranjan NS, Azad SM, Fleming AN, Liew SH. Long-term results of primary syndactyly correction by the trilobed flap technique. Br J Plast Surg 2005; 58 (1) 14-21
    CrossrefPubMedGoogle Scholar
  • 31 Niranjan NS, DeCarpentier J. A new technique for the division of syndactyly. Eur J Plast Surg 1990; 13 (3) 101-104
    CrossrefPubMedGoogle Scholar
  • 32 Bandoh Y, Yanai A, Seno H. The three-square-flap method for reconstruction of minor syndactyly. J Hand Surg Am 1997; 22 (4) 680-684
    CrossrefPubMedGoogle Scholar
  • 33 Sherif MM. V-Y dorsal metacarpal flap: a new technique for the correction of syndactyly without skin graft. Plast Reconstr Surg 1998; 101 (7) 1861-1866
    CrossrefPubMedGoogle Scholar
  • 34 Aydin A, Ozden BC. Dorsal metacarpal island flap in syndactyly treatment. Ann Plast Surg 2004; 52 (1) 43-48
    CrossrefPubMedGoogle Scholar
  • 35 Teoh LC, Lee JY. Dorsal pentagonal island flap: a technique of web reconstruction for syndactyly that facilitates direct closure. Hand Surg 2004; 9 (2) 245-252
    CrossrefPubMedGoogle Scholar
  • 36 Hsu VM, Smartt Jr JM, Chang B. The modified V-Y dorsal metacarpal flap for repair of syndactyly without skin graft. Plast Reconstr Surg 2010; 125 (1) 225-232
    CrossrefPubMedGoogle Scholar
  • 37 Gao W, Yan H, Zhang F , et al. Dorsal pentagonal local flap: a new technique of web reconstruction for syndactyly without skin graft. Aesthetic Plast Surg 2011; 35 (4) 530-537
    CrossrefPubMedGoogle Scholar
  • 38 Yildirim C, Sentürk S, Keklikçi K, Akmaz I. Correction of syndactyly using a dorsal separated V-Y advancement flap and a volar triangular flap in adults. Ann Plast Surg 2011; 67 (4) 357-363
    CrossrefPubMedGoogle Scholar
  • 39 Savaci N, Hoŝnuter M, Tosun Z. Use of reverse triangular V-Y flaps to create a web space in syndactyly. Ann Plast Surg 1999; 42 (5) 540-544
    CrossrefPubMedGoogle Scholar
  • 40 Shinya K. Dancing girl flap: a new flap suitable for web release. Ann Plast Surg 1999; 43 (6) 618-624
    CrossrefPubMedGoogle Scholar
  • 41 Tan O, Atik B, Ergen D. Versatile use of the VM-plasty for reconstruction of the web space. Ann Plast Surg 2005; 55 (6) 623-628
    CrossrefPubMedGoogle Scholar
  • 42 Matsumine H, Yoshinaga Y, Fujiwara O, Sasaki R, Takeuchi M, Sakurai H. Improved “bell-bottom” flap surgical technique for syndactyly without skin graft. Plast Reconstr Surg 2011; 128 (5) 504e-509e
    CrossrefPubMedGoogle Scholar
  • 43 Greuse M, Coessens BC. Congenital syndactyly: defatting facilitates closure without skin graft. J Hand Surg Am 2001; 26 (4) 589-594
    PubMedGoogle Scholar
  • 44 Bates SJ, Hansen SL, Jones NF. Reconstruction of congenital differences of the hand. Plast Reconstr Surg 2009; 124 (1, Suppl) 128e-143e
    CrossrefPubMedGoogle Scholar
  • 45 Dobyns JH. Congenital hand deformities. In: Green DP, , ed. Operative Hand Surgery. Vol. 1. 2nd ed. New York: Churchill Livingstone; 1985: 346-366
    Google Scholar
  • 46 Golash A, Watson JS. Nail fold creation in complete syndactyly using Buck-Gramcko pulp flaps. J Hand Surg [Br] 2000; 25 (1) 11-14
    CrossrefPubMedGoogle Scholar
  • 47 Buck-Gramcko D. Congenital malformations. In: Buck-Gramcko D, Millesi H, Lister G, , eds. Hand Surgery. Vol. VI. Stuttgart: Georg Thieme Verlag; 1988: 1242-1248
    Google Scholar
  • 48 Lundkvist L, Barfred T. A double pulp flap technique for creating nail-folds in syndactyly release. J Hand Surg [Br] 1991; 16 (1) 32-34
    CrossrefPubMedGoogle Scholar
  • 49 Sugihara T, Ohura T, Umeda T. Surgical method for treatment of syndactyly with osseous fusion of the distal phalanges. Plast Reconstr Surg 1991; 87 (1) 157-164
    CrossrefPubMedGoogle Scholar
  • 50 Johansson SH. Nagelwallbildung durch thenarlappen bei komplettter syndaktylie. Handchirurgie 1982; 14: 199-203
    PubMedGoogle Scholar
  • 51 Sommerkamp TG, Ezaki M, Carter PR, Hentz VR. The pulp plasty: a composite graft for complete syndactyly fingertip separations. J Hand Surg Am 1992; 17 (1) 15-20
    CrossrefPubMedGoogle Scholar
  • 52 Coombs CJ, Mutimer KL. Tissue expansion for the treatment of complete syndactyly of the first web. J Hand Surg Am 1994; 19 (6) 968-972
    CrossrefPubMedGoogle Scholar
  • 53 Dao KD, Shin AY, Billings A, Oberg KC, Wood VE. Surgical treatment of congenital syndactyly of the hand. J Am Acad Orthop Surg 2004; 12 (1) 39-48
    PubMedGoogle Scholar
  • 54 Mishra A, Nelson K, McNally S, Gorst C, McArthur P. Laser ablation of abnormal skin pigmentation post syndactyly release. J Plast Reconstr Aesthet Surg 2010; 63 (10) 1753-1755
    CrossrefPubMedGoogle Scholar