Clinical application of dorsal pentagonal flap transfer for web reconstruction in the treatment of congenital syndactyly

Abstract

Objective To introduce a surgical technique for web reconstruction in the treatment of congenital syndactyly of the fingers or toes.Methods Five patients (2 with toe syndactyly and 3 with finger syndactyly) were included in the study.A pentagonal flap on dorsum of the hand or foot was designed over the dorsum of the proximal phalanx of the congenital syndactyly.The axes of the two involved digits served as the borders of the flap,defining the width of the flap from the metacarpophalangeal (metatarsophalangeal) joints of one digit to the other.After multiple Z-plasty was done to separate the syndactyly,the pentagonal flap was advanced to form the web.The adjacent sides of the separated fingers were directly covered with the triangular flaps from the Z-plasty without the need of skin graft.Results All patients were follow-up for 4 months to 2 years.All the flaps survived.There was no flexion contracture of the fingers (toes).Except for one case of hypertrophic scar formation,all patients' parents were satisfied with the web depth and appearance of the digits.Conclusion Dorsal pentagonal advancement flap is a good option for web reconstruction in simple finger or toe syndactyly.It leads to good appearance and satisfactory functions.Besides,this procedure eliminates the need of skin graft thus effectively shortens the surgery time. Key words: Syndactyly; Surgical flaps; Treatment outcome; Web