Dorsal VY Advancement Flap: A Technique for Repair of Simple Syndactyly That Facilitates Direct Closure.

Abstract

ABSTRACT 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.Key Words: Simple syndactyly, Dorsal V-Y advancement flap, Defatting.