Background: Simple syndactyly is a common congenital upper extremity difference. Traditional reconstructive approaches utilize skin grafts; however, recent studies suggest skin graftless techniques may improve outcomes. We hypothesized that patients who underwent reconstruction with a skin graftless dorsal metacarpal island VY advancement flap would have fewer postoperative complications compared to those released with a dorsal rectangular flap with skin grafts.
Methods: Patients 0-17 years of age presenting for primary reconstruction of simple syndactyly were retrospectively analyzed at a large pediatric hospital. Medical records were identified using ICD-9/10 codes, CPT codes, and case logs from six 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 (greater than 30 days) included web creep and development of pathologic scar formation.
Results: In total, 213 syndactyly repairs from 153 patients were analyzed (rectangular=94 webspaces, 58 patients; VY=119 webspaces, 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% vs 1.8%, p<0.001; 19.1% vs 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.
Conclusion: Simple syndactyly releases with the skin graftless technique produces fewer complications compared to the traditional approach with skin grafts.
Copyright © 2024 by the American Society of Plastic Surgeons.