Zigzag Incisions Research Articles

A prospective randomized comparison of functional and cosmetic outcomes of a coronal zigzag incision versus a conventional straight incision pattern for craniotomy.

Wound healing problems after neurosurgical procedures can lead to serious complications and may require complex revision or even reconstructive surgery. Therefore, optimal surgical management is critical to prevent complications. In a recent experimental study in animals, the authors demonstrated the superiority of a zigzag skin incision over a straight incision pattern. In this study, the authors applied these findings to clinical situations of neurosurgical patients with an indication for a coronal skin incision. The aim of this study was to objectively assess the functional and cosmetic outcomes between straight coronal and zigzag incisions in neurosurgical procedures. This prospective, randomized, controlled, single-center trial included adult patients undergoing frontal craniotomy for cerebrovascular or tumor pathologies. The study primarily included patients who were not expected to receive adjuvant radiation or chemotherapy. The zigzag incision was standardized using a template. A common straight skin incision behind the hairline served as a control. Complication rates, functional (2-point discrimination, width of the wound, Vancouver Scar Scale [VSS], and Patient and Observer Scar Assessment Scale [POSAS]), and cosmetic outcomes were assessed postoperatively and at 3-month follow-up evaluations. Additionally, all patients answered a wound-specific questionnaire and the SF-36 questionnaire. Twenty-eight patients were randomized to the zigzag and 29 to the straight incision groups. Indications for surgery were cerebrovascular in 16 cases and tumors in 41 cases. Risk factors for wound healing were equally distributed in both groups. One patient in the zigzag group with poor postoperative compliance required surgery for secondary wound healing problems. Overall, the width of the scar was significantly smaller (p = 0.001) and local 2-point discrimination better (p = 0.005) in the zigzag group. Scores on the VSS (p = 0.003) and POSAS (p = 0.005) proved to be significantly superior in the zigzag group as well. A zigzag coronal skin incision pattern leads to significantly superior functional and cosmetic outcome scores. For certain patient groups, these findings may prove to be practice-changing.

Outstanding surgeon of the twentieth century, professor Natalya Ivanovna Butikova

The purpose of the study is to highlight the scientific, clinical, pedagogical and social activities of the outstanding maxillofacial and plastic surgeon, Doctor of Medical Sciences, Professor N.I. Butikova.
 Material and methods. Based on the analysis of domestic literature, as well as the life, professional activities and scientific works of Doctor of Medical Sciences, Professor N.I. Butikova to present her role in the formation and development of domestic maxillofacial and plastic surgery.
 Results. Information from the life of a well-known surgeon in our country, one of the patriarchs of Russian pediatric traumatology and maxillofacial surgery, Doctor of Medical Sciences, Professor Natalia Ivanovna Butikova, who turned 110 years old in 2020, is presented. The formation of N.I. Butikova as a doctor, researcher and teacher, her activities during the Great Patriotic War are noted. The main directions of her scientific activity in the development and improvement of methods for the treatment of gunshot injuries of organs and tissues of the maxillofacial region and neck, the rehabilitation of the wounded with defects in the jaws and tissues of the oral region using the methods of bone autoplasty and Filatov's stalk are highlighted. Natalya Ivanovna paid much attention to improving the treatment of face and neck burns and their consequences, as well as to surgical methods for eliminating mimic muscle paralysis. Its role in the development of oncostomatology, combustiology, pediatric traumatology and orthopedics is revealed. N.I. Butikova developed surgical methods for the treatment of syndactyly in children under the age of one year and the first years of life using zigzag incisions, improved the methods of free tissue grafting and plasty with split skin grafts, and proposed an apparatus for preventing secondary contraction of skin grafts during transplantation.
 Conclusions. It is emphasized that she was one of the pioneers of domestic maxillofacial surgery. N.I. Butikova, being one of the founders of domestic surgery, the creators of the school of pediatric traumatologists and orthopedists, as well as maxillofacial surgeons, is rightfully recognized as one of the patriarchs of national healthcare.

Finding the Optimal Surgical Incision Pattern-A Biomechanical Study.

The closure of wounds and subsequent optimal wound healing is essential to any successful surgical intervention. Especially on parts of the body with limited possibilities for local reconstruction, optimal distribution of load is essential. The aim of the present study was therefore to examine three different incision patterns, conventional straight, Lazy-S and Zigzag, with regard to their biomechanical stability and mode of failure on a porcine skin model. Our results demonstrate the superior biomechanical stability of Lazy-S and Zigzag incision patterns with perpendicular suture placement. This holds true, in particular, for Zigzag incisions, which showed the highest values for all parameters assessed. Moreover, the observed superior stability of Lazy-S and Zigzag incision patterns was diminished when sutures were placed in tensile direction. The conventional straight incision represents the standard access for a large number of surgical procedures. However, we were able to demonstrate the superior biomechanical stability of alternative incision patterns, in particular the Zigzag incision. This is most likely caused by an improved distribution of tensile force across the wound due to the perpendicular placement of sutures. Moreover, this technique offers additional advantages, such as a better overview of the operated area as well as several cosmetic improvements. We therefore advocate that the surgeon should consider the use of a Zigzag incision over a conventional straight incision pattern.

DALK with Femtosecond Zig-zag Incisions

DALK with Femtosecond Zig-zag Incisions

Abstract P3-13-08: Usefulness of periareolar zigzag incision in oncoplastic breast-conserving surgery

Abstract Background Breast-conserving surgery (BCS) has been performed as a standard procedure because the addition of radiation therapy after breast-conserving surgery in early breast cancer patients is similar to that of mastectomy.The surgical methods for breast cancer have been developed in recent years, and the cosmetic aspect has become important.Several incisions are used to reduce the scar to the incision site during BCS. The periareolar incision is often used when the small tumor relatively close to the nipple. However, periareolar incision does not have sufficient field of sight, which can result in difficult or impossible operations if the tumor is large or far from the nipple. In plastic surgery, various methods such as zigzag incisions have been recommended to achieve satisfactory esthetic results. The periareolar zigzag incision has the advantage of a not only good surgical field but also contributed to better surgical scars. The purpose of this study was to evaluate the oncological safety of procedures by studying the status of the surgical margins of the excised tumor specimen and reduces the need for further surgery Methods From January 2016 to November 2017, we conducted a survey of female patients who underwent BCS using zigzag incision. Patients with exclusion criteria were excluded from this study if they had a Patients with bilateral breast cancer or neoadjuvant chemotherapy was included in the study. Intraoperative frozen section margin was evaluated in all patients and additional resection was performed when the positive margin was present. Final margin status was determined by examination of the permanent paraffin-embedded sections. In patients with invasive breast cancer or relatively large carcinoma in situ, axillary surgery was performed according to the presence of axillary metastasis. Patients characteristics, tumor characteristics, operative time, size of the specimen and the distance from the tumor to nipple were evaluated Results 393 patients were enrolled in the study, including 9 patients with bilateral breast cancer, and a total of 402 cases of BCS surgery were analyzed. Thirty-five patients received neoadjuvant chemotherapy. The median age of the patients was 51 (range: 25-84 years), the median time of operation was 72 minutes in patients who did not undergo axillary surgery or sentinel node biopsy only, and 83 minutes in patients who underwent axillary node dissection or supraclavicular node dissection. The median tumor size was 1.6 cm (range: 0-8.8 cm), median tumor distance from the nipple was 3.0 cm (range: 0.4-8.1 cm), mean excised specimen sized was 5.0 cm (range: 0.9-15.0 cm). Frozen biopsy of the resection margin during surgery revealed tumor-positive in 69 (17.2%) cases and re-excision was performed. All patients were discharged with no sign of infection or skin necrosis. Conclusions The periareolar zigzag incision technique has good cosmetic results and provides a sufficient surgical field, which can be useful for removing relatively large tumors or tumors far from the nipple. Citation Format: Ko B, Kim H, Chung I, Lee S, Kim J, Lee J, Son B, Ahn SH. Usefulness of periareolar zigzag incision in oncoplastic breast-conserving surgery [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-08.

Clinical analysis of the double-wing flap for treatment of toe syndactyly

Objective: To explore the clinical effect of double-wing flap for the treatment of toe syndactyly. Methods: Retrospective analysis of 47 patients (60 syndactyly toes) who underwent double-wing flap to reconstruct toe web space in orthopedics department of the Third Affiliated Hospital of Zhengzhou University from February 2010 to October 2017.There were 21 males and 26 females, with an average age of 18.9 months (range: 10-48 months). All patients were treated with zigzag incisions to separate the toe syndactylys without skin grafts.The condition of wound healing and appearance of toes were observed. Results: The average follow-up time was 62.3 months (range: 6 to 80 months). There were no complications such as hematoma, infection, flap necrosis and no flexion contracture and obvious scar hyperplasia in all the 47 cases, 4 of the 60 webs developed web creep.All webs had good appearance with 45 degrees inclination from the dorsal to the metatarsal side and had good flexion and abduction function. Conclusions: The double-wing flap is a simple and safe operation for toe syndactyly which has a good clinical effect.

The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment: A STROBE compliant study.

Numerous techniques have been developed that use various flaps to treat syndactyly. Skin grafts have often been used to cover remaining surgical defects. The long-term aim of surgery is to find new methods of separating the digits without using skin grafts. This paper describes a new surgical technique for the correction of simple, incomplete, and complete syndactyly. The technique consists of a dorsal double-wing flap to cover the newly created web space and zigzag incisions in the fingers, thus avoiding the use of skin grafts in this space. Overall, 35 web spaces in 24 patients were treated using this technique. Patient follow-up ranged from 6 months to nearly 5 years. There were no complications such as hematoma, infection or flap necrosis, and no fingers needed skin grafts after separation. The average operative time for each web space was approximately 45 minutes. Ninety-seven percent of patients treated with the dorsal double-wing flap procedure achieved good function, and superior cosmetic results following a single surgery. The technique is simple, rapid, safe, and easily performed and does not require the use of skin grafts.

Intérêt d’un substitut dermique en 1 temps (Matriderm©) dans la couverture des pertes de substance de la face latérale des doigts longs lors d’une cure de syndactylie congénitale : à propos de 20 commissures

Surgical treatment of congenital syndactylies is based on the creation of a new commissure - with a commissural flap - and on the management of fingers lateral faces - with mirror zigzag incisions. Lateral skin defects are covered by full-thickness skin graft. Since their discover 30 years ago, dermal substitutes applications have been enlarged. We have wandered if these technique could be interesting for the treatment of these lateral skin defects. We have launched a monocentric and retrospective study with only one surgeon. The assessor and the operator were different. Included patients have a simple or complex congenital syndactyly, complete or not, associated with a syndrome or not. Children with a first web space syndactyly were excluded. Surgical treatment was performed with a dorsal commissural flap, with mirror incisions and with a lateral skin defects coverage by dermal substitute (Matriderm(©)) and split-thickness skin graft taken from the scalp. The initial assessment criterion was the quality of the scare measured by the OSAS score. Web creep (Whitney's scale) and time of surgery were two minor criteria. Twenty commissures (11 children) have been included between 2008 and 2013. Fourteen complex syndactylies were noted. The average aftercare was equal to 2.7 years (0.5-5.5 years). Interventions were performed at the age of 1.8 years (0.5-4 years). Surgical time was equal to 44.6 min (22-95 min). Patients OSAS score was 11.9 (6-18). It was 12.2 (60-20) for complex forms and 11.9 (10-16) for simple forms. Graft weren't hairy. There was no complication on the donor site. Whitney's score was 1.2 (0-3) and three web spaces were reoperated. We think that the use of dermal substitute Matriderm(©) is a new and serious alternative to treat congenital syndactylies. Results have to be confirmed by a new study which would compare this material to full-thickness skin graft, gold standard technique for these skin defects.

Principe du doigt-banque en main congénitale : à propos d’une syndactylie bilatérale

The spare-parts concept is well described in traumatology of the hand. Tissues of a scarified ray are used to reconstruct another damaged finger. We will detail an application in pediatric hand through a clinical case. We describe a patient presenting a bilateral complete and non-complex syndactyly of the third web space associated with a bilateral hexadactyly classified as type B according to the Temtamy and Mc Kusick's classification. The treatment of the syndactyly was performed with a dorsal flap for the web space and with longitudinal zigzag incisions in mirror. Skin loss of the lateral sides of the fingers was covered by the full-thickness graft taken on the supernumerary finger which was treated in the same surgical time. This application of the spare-parts concept allows only one surgical site with absence of scar on the donor site and a skin graft close to the skin loss on the finger. The spare-parts concept can be applied in some cases of pediatric hand and must be a tool for the surgeon.

Medical tactic in hand polydactyly in children

Untimely correction of anomalies of fingers and hands or inefficiently performed reconstructive operations may affect the processes of adaptation of children to life. Objective: To improve outcomes in children with polydactyly by optimizing the methods of surgical correction of congenital hand pathology. Methods: During the period from 2000 to 2012 in 118 patients (70 boys, 48 girls, age to 6 years) with polydactyly there were performed 141 operations on 136 hands. There were 68 children with radial form of polydactyly, 17 with ulnar form, and 3 with central one. For establishment of the nature of the pathology examination with using of radiological, CT, and ultrasound dopplerography mapping was done. Results: In the case of the main finger deformity after removal of additional finger we performed corrective osteotomies, modeling resections of articular surfaces, and restored capsular-ligamentous apparatus. In cases of ulnar polydactyly with thickening of V metacarpal bone on the wide head of which there are two claw like little fingers we removed less developed one, cut off the abductor digiti minimi, restored lateral metacarpophalangeal ligament, fixed the muscle to the proximal phalanx, angular deformity of the V finger we eliminated by wedge osteotomy with K-wire fixation. In cases of central polydactyly after removal of extra finger we used created from a remote segment reserve of skin for closing the skin defect on lateral surfaces of the fingers with simultaneous correction of axial deformities. Long-term outcomes were followed up during the period of 1 to 10 years in 78 children: good results were obtained in 44 cases, satisfactory — in 27, and unsatisfactory — in 7 cases. Errors and complications: deviation of the main finger, nonunion of bone surfaces, scar deformities, limitation of movement. Conclusions: While choosing the method of surgery and duration of its execution one should establish the primary and the secondary fingers in cases of radial polydactyly. Zigzag incisions, rational skin, bone and tendon plasty allow to prevent the formation of scar contractures and secondary deformities of fingers and contribute to the restoration of the hand function.

Expansion Abdominoplasty for a Pregnant Woman With Severe Abdominal Wall Contracture due to a Major Burn During Childhood

Normal abdominal expansion that occurs as a result of hormonal actions during pregnancy may be prevented by the presence of excessive scar tissue in individuals who have received severe burns. In these instances, the lack of abdominal expansion may cause maternal pain and put the infant at risk. A 23-year-old pregnant woman presented with severe abdominal wall contracture due to a major burn sustained during childhood. At 20 weeks of pregnancy, expansion abdominoplasty, consisting of zigzag incisions in the fascia to release the contracture and a split-thickness skin graft, was performed. The patient gave birth, via a planned cesarean operation at 36 weeks of pregnancy, to a baby girl in good condition; the postpartum course was uneventful.

Penetrating keratoplasty using femtosecond laser-enabled keratoplasty with zig-zag incisions versus a mechanical trephine in patients with keratoconus

Background/aimsThis paper will compare the visual outcomes of two different penetrating keratoplasty (PKP) techniques in patients with keratoconus. It is a retrospective comparative surgical case series of 116 keratoconus patients...

A Novel Mutation of the Decorin Gene Identified in a Korean Family With Congenital Hereditary Stromal Dystrophy

To identify mutations in the decorin (DCN) gene in family members with congenital hereditary stromal dystrophy (CHSD). Bilateral deep anterior lamellar keratoplasties using a big-bubble technique and a 60-kHz femtosecond laser (IntraLase; Abbott Medical Optics, Irvine, CA) for zig-zag incisions were performed for the patients with CHSD. Medical records were reviewed for the proband's daughter with the same corneal manifestation who had bilateral penetrating keratoplasty 8 years before. After obtaining informed consent from the pediatric patients and their guardians, we sampled the peripheral blood of 2 patients and the proband's son who had no clinical manifestation of CHSD. Genomic DNA was extracted from white blood cells. Eight exons and exon-intron boundaries of the DCN gene were amplified by polymerase chain reaction using specific primers for each exon. The polymerase chain reaction products were subsequently analyzed using the direct DNA sequencing method. The proband and her daughter showed typical pathological findings of CHSD, such as lamellae of normal collagen fibrils separated by layers of abnormal collagen filaments, as seen on electron microscopic examination. A novel mutation c.947delG (p.Gly316AspfsX12) was identified in the exon 8 of the DCN gene, which might lead to an abnormal truncation of the C-terminal in the decorin protein. However, the proband's son who was without any sign of CHSD showed a normal sequence of the DCN gene. We report a novel frameshift mutation of the DCN gene in a Korean family with CHSD.

A Comparative Study of Scar from Zigzag Incisions with Those from Linear Incisions Made along Skin Tension Lines during Routine Surgery

Sir: Surgical incisions are commonly linear. It is recommended that they be placed along skin tension lines to obtain a fine line and less conspicuous scar.1,2 However, made against these lines, a linear incision produces a thick and prominent scar, which can be avoided by making the incision zigzag.3 Presuming that a zigzag incision along the skin tension lines may produce a scar that is finer and less perceptible than a linear scar in the same direction, a study was undertaken. Observing due ethics, six adult female patients, without any history of keloid or hypertrophic scars, undergoing hysterectomy, were subjected to Pfannenstiel incision, with the right half being made zigzag in a continuous W fashion and the left half linear. Assessment of the scars was performed after a minimum of 18 months. Photographs of all scars and magnetic resonance imaging scans of two scars were obtained. Evaluation was performed through the patient, a clinical observer, and six image observers by noting the symptoms, degree of general visibility, contour, width, and color match with the surrounding skin. A score ranging from 1 to 4 was allotted to each parameter in order of most to least acceptable grade. Comparison of color and width was performed using the Wilcoxon signed rank test. Five patients (83 percent) returned for follow-up. All of the scars were symptom free and flat, with a score of 1.0 each, showing equality. The average score for color match with the surrounding skin was 1.8 for the zigzag scars and 2.0 for the linear scars, displaying near equality, with a nonsignificant value of p = 0.564. The average ratio of width of zigzag to linear scar was 1:1.9, showing a notable difference (Fig. 1), with a nonsignificant value of p = 0.216, which could be attributable to the small size of the sample.Fig. 1.: Case 2. The patient at 35-month follow-up. The arrows indicate the visible linear scar of the left half of the incision and at the area of zigzag scar of the right half of the incision, which is almost imperceptible.Visibility of the zigzag scars was less (Fig. 1), with a uniformly average score of 1.6 compared with 1.8 and 2 for linear scars according to the patient and the observers, respectively. There was no interobserver variation. Magnetic resonance imaging scan of the scar (Fig. 2) showed less hypointensity of the zigzag scar, suggesting greater maturation.Fig. 2.: Case 2. Magnetic resonance imaging scan, sagittal view, of the abdomen at 6-mm depth showing hypointensity under the linear scar (left side) and isointensity under the zigzag scar (right side).The following propositions are being made to explain the scar behavior: Razor effect: The acute angles of the triangular flaps of the zigzag scar act as a razor, cutting the newly forming collagen fibers, breaking the long scar into multiple short segments. Rope phenomenon: The scar is a rope of collagen fibers and, according to the law of strength of materials,4 short segments, being exposed to less load than a long scar, need to have smaller cross-sections to bear the same intensity of stress. That is why the zigzag scars are less wide. The lesser visibility of the zigzag scar is caused not only by the difficulty they pose to the eyes to follow them5 but also by their lesser width. The thinner scars mature faster than thicker scars, as seen on the magnetic resonance imaging scans. The findings favor a zigzag incision for all routine operations. However, these are preliminary findings and further studies are needed. Satyanarayan Mishra, M.S., M.Ch. Division of Plastic Surgery Koppada Lavanya Kumari, M.D. Division of Obstetrics and Gynecology Rajah Muthiah Medical College Hospital Annamalai University Annamalainagar, India

Long-Term Outcomes of Web Creep, Scar Quality, and Function After Simple Syndactyly Surgical Treatment

Syndactyly is the second most common congenital malformation of the hand, and reports of the incidence of web creep after surgery vary. To evaluate our outcomes of simple syndactyly surgical release, we conducted a retrospective analysis of patients treated between January 1965 and December 2007. After matching for inclusion criteria, we recruited 19 patients with 26 affected web spaces for clinical examination. Outcomes evaluation included grading of web creep, Vancouver Scar Scale, assessment of complications and subjective patient analysis, range of motion, degree of finger abduction, power, and 2-point discrimination. Mean age at follow-up was 18 years (range, 6-50 y), with a mean age of 4.4 years (range, 7 mo to 15 y) at surgery and mean follow-up of 11.5 years (range, 5-35 y). Surgical management consisted of palmar and dorsal triangular skin flaps for creation of the new commissure, and multiple zigzag incisions for separation of digits. For tension-free closure, full-thickness skin grafts were harvested as needed. We observed web creep up to the proximal third of the distance between palmar metacarpophalangeal and proximal interphalangeal joint crease in 2 web spaces. All other web spaces had either a soft web equivalent to the contralateral (unaffected) side (n = 13) or no web advancement with thickening of the interdigital space (n = 11). The scar quality as assessed with the Vancouver Scar Scale revealed a height below 2 mm in 24 of 26 web spaces, with close to normal to supple pliability in 20 of 26 web spaces. There were no considerable differences for range of motion, degree of finger abduction, power, or 2-point discrimination between the affected and unaffected sides. In 17 of 24 cases in which full-thickness skin grafts from the groin region were used, patients reported commissural hair growth in the grafted region. Evaluation of the long-term outcomes of surgical treatment for simple syndactyly at our institution demonstrated a low incidence of web creep. When choosing the groin as a donor area for full thickness skin grafts, we recommend harvesting from the lateral third of the inguinal crease, to avoid esthetic compromise associated with the beginning of hair growth in puberty. Therapeutic IV.

Deep anterior lamellar keratoplasty with femtosecond-laser zigzag incisions

We describe a technique that uses IntraLase-created zigzag incisions for deep anterior lamellar keratoplasty. In this technique, the laser creates a precise incision that extends to within 70 microm of the recipient Descemet membrane. The deep incision minimizes air escape into the peripheral cornea during big-bubble formation. In cases that require hand dissection, the deep incision provides a reference for gauging the dissection depth. The angled incision edge facilitates final stromal excision with scissors. Compared with standard vertical incisions, the zigzag incision provides an interlocking wound configuration and facilitates matching the donor and recipient anterior surfaces.

Refinement of Three Periductal Dermofibrous Flaps Method for Correction of Inverted Nipples

The inverted nipple, which may be congenital or acquired by trauma and inflammation, can lead to both functional and aesthetic problems. Many corrective techniques have been proposed for inverted nipple in the literature. The method of three periductal dermofibrous flaps offers a geometrically balanced solution for inverted nipple. On the basis of three periductal dermofibrous flaps, some refinements were proposed to prevent scar tenting and bring judgment of final dimension in this study. Firstly, three zigzag incisions at nipple-areolar junction were introduced to keep the nipple-areolar angle from scar tenting. Secondly, the dimension of three remaining arcs will form the resulting circumference of new nipple. Thirty-nine nipples of 22 patients were corrected with this refining method since 2003. Poor projection occurred in one patient and size discrepancy was noted in 3 patients. All of the unfavorable results were resolved by another one surgery. In conclusion, this method provides a predictable result for inverted nipples.

Results of Penetrating Keratoplasty Performed with a Femtosecond Laser Zigzag Incision Initial Report

To determine the initial outcomes of utilizing a femtosecond laser to perform penetrating keratoplasty incisions in a zigzag pattern. Retrospective consecutive surgical series. Patients undergoing full-thickness corneal transplant surgery in a referral academic practice. The IntraLase femtosecond laser performed matching donor and host zigzag incisions in a consistent pattern in 13 eyes of 13 patients. Topographically determined astigmatism, imaging of incisions by anterior segment optical coherence tomography, and best spectacle-corrected visual acuity (BSCVA). Postoperative follow-up ranged from 3 to 9 months. Mean astigmatism was < or =3.0 diopters (D) at all intervals beginning at 1 month postoperatively. Maximum astigmatism was 4.25 D from month 3 onward. Nine eyes (69%) had < or =3 D and 6 eyes (46%) had < or =2 D by month 3. In the 8 eyes with full vision potential, 7 (87.5%) had BSCVA> or =20/30 by month 3; the eighth eye had improved to 20/25 by month 6. Optical coherence tomography images showed excellent anterior and posterior wound alignment, including one eye where the running suture loosened and was fully removed before month 3. The femtosecond laser-generated zigzag incision is biomechanically stable, resulting in excellent wound apposition, wound integrity with minimal suture tension, and recovery of good levels of BSCVA with moderate astigmatism within months of surgery.

Long-term results of primary syndactyly correction by the trilobed flap technique

This paper describes the long term results of a surgical technique used for correction of syndactyly. This technique has been practised by the senior author since 1987 and was published in 1990. The technique involves the use of a dorsal trilobed flap for the reconstruction of the commissure and zig-zag incisions for the fingers. This technique does not require the use of skin grafts. This technique has been used in 62 webs in 44 patients. In this total group, there were 30 patients of primary hand syndactyly with 40 webs. Seventeen patients of primary syndactyly with 25 webs were followed up. The follow-up of these patients ranged from 2 years to 12 years. The long term results reveal a simple, effective technique which does not require the use of skin grafts, and is associated with good functional and far superior cosmetic results.

Congenital syndactyly: defatting facilitates closure without skin graft.

We attempted to correct 24 syndactylies without skin grafts in 16 consecutive patients. Digital volume was decreased by defatting the full length of the fingers and the interdigital space. Closure of the zigzag incisions on both fingers could then be achieved with minimal tension and did not seem to be related to the type of flap used for commissure resurfacing. We used 2 different types of flap closure. We noted that defatting was a more important determinant of whether the wound could be closed without graft than flap configuration. The new type of flap may represent an improvement for web appearance but is not a determination for finger closure. Only a complex syndactyly involving 3 adjacent atrophied fingers required a skin graft for separation. The results were evaluated after a mean follow-up period of 22 months. Three patients had a complication: an intraoperative digital nerve laceration, a scar contracture, and a recurrence of the treated commissure due to local infection. Two patients needed another surgical procedure. Supple and good quality scars were observed in the other patients. No conspicuous change in finger contour compared with the nonsyndactylized fingers was observed.