There is no financial information to disclose. Congenital syndactyly occurs in isolated and syndromic forms; method of reconstruction must be tailored to the type of syndactyly, and postoperative function will depend on the pre-operative state of the hand in addition to the method of reconstruction selected. All patients who underwent webspace reconstruction for congenital syndactyly by the senior author over an 18 year period were included in this study. Data included demographics, medical history, anatomy and severity of syndactyly, surgical technique, follow-up and need for revision. Patients who underwent hand surgery prior to their first clinic visit were excluded from outcomes analysis. Logistic regression was performed to identify factors that were associated with postoperative wound complications and revision. Reconstruction was performed for 182 patients with 391 webspaces; 21 patients were referred from outside surgeons and excluded from analysis. Twenty-six patients had complications (16%), of which 13 (8%) required revision. The most common complications were web creep (n = 10), scar contracture (n = 6), and flexion contracture (n = 5). Dorsal VY advancement flap was the most common method for reconstructing simple incomplete syndactyly and was associated with decreased risk of complication in the 3rd webspace (OR = 0.427, P = 0.006), while triangular flaps and skin graft were associated with increased complications (OR = 2.75, P < 0.001). Presence of a complicated hand anomaly did not significantly increase the likelihood of complications (P = 0.21). •Syndactyly is a common congenital hand condition that occurs as both an isolated anomaly and as part of several syndromic diagnoses.•We describe the largest retrospective cohort of congenital syndactyly reconstruction to date and discuss important technical and clinical considerations to minimize postoperative complications and revisional surgery.