Evaluation of hexagonal flap for Syndactyly repair

Abstract

Background and objective: Syndactyly is among the most commonly treated hand anomalies by plastic surgeons. Since the 1800s,over 46 corrective procedures have been described. These techniques involve using different flap designs and full-thickness skin graft or depending on graftless techniques to achieve the goals. Some articles concluded that graftless techniques have shorter operative times and fewer postoperative complications. The aim of the study is to evaluate the use of a local "hexagonal" dorsal advancement flap (HDAF) for syndactyly repair without using a skin graft. Methods: Between March 2021 and March 2022, we operated on 18 subjects (25 web spaces) in Rizgary and Hawler teaching hospitals in Erbil. Our study subjects were children and adults with different types of syndactyly (congenital, recurrent, and post-burn). We studied the early outcomes of using HDAF and straight-line incision for syndactyly repair. Results: The patients' ages ranged from 1.5 to 50 years, and the mean follow-up period was 6.3 months (1-13 months). The mean operation time was 98.5 minutes (40-160 minutes). Wounds were closed primarily without skin graft in 96% of the cases. We encountered neither a flap loss nor recurrences of syndactyly. The mean abduction angle achieved was 36.5º. All patients and their caregivers were satisfied with the aesthetic outcome. Conclusion: Syndactyly repair using a hexagonal dorsal advancement flap and straight-line separation of the fingers is a safe and straightforward technique regardless of age and syndactyly class or type. It results in a relatively short procedure with good-looking and well-functioning fingers.