Evaluation of hexagonal flap for Syndactyly repair
DOI:
https://doi.org/10.15218/zjms.2024.23Keywords:
Syndactyly repair in adults, Congenital hand anomaly, Recurrent syndactyly, Post-burn syndactylyAbstract
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.
Metrics
References
Little KJ, Cornwall R. Congenital anomalies of the hand-principles of management. Orthop Clin North Am 2016; 47(1):153–68. http://dx.doi.org/10.1016/j.ocl.2015.08.015
Rahgozar P, Chung KC. Common congenital hand anomalies. In: Chung KC, editor. Grabb and smith plastic surgery. 8thed. Philadelphia: Wolters Kluwer; 2020. P. 3105–33.
Weinzweig J. Plastic surgery secrets plus. 2nded. Philadelphia: Mosby Elsevier; 2010. P. 767.
Hoevenaren IA, Vreeken RD, Verhulst AC,Ulrich DJ, Maal TJ, Wagner T. Virtual Incision Pattern Planning using Three-Dimensional Images for Optimization of Syndactyly Surgery. Plastic and Reconstructive surgery-Global Open 2018; 6(3):e1694. DOI: 10.1097/gox.0000000000001694. PMID: 29707454; PMCID: PMC5908514.
Jordan D, Hindocha S, Dhital M, Saleh M, Khan W. The epidemiology, genetics and future management of syndactyly. Open Orthop J 2012; 6:14–27. DOI: 10.2174/1874325001206010014. Epub 2012 March 23rd. PMID: 22448207; PMCID: PMC3308320.
Ahmed H, Akbari H, Emami A, Akbari MR. Genetic overview of syndactyly and polydactyly. Plast Reconstr Surg - Glob Open 2017; 5(11):1–8. Available from: https://pubmed.ncbi.nlm.nih.gov/29263957/
Mende K, Watson A, Stewart DA. Surgical treatment and outcomes of syndactyly: a systematic review. J hand Surg Asian-Pacific 2020; 25(1):1–12. https://pubmed.ncbi.nlm.nih.gov/32000609/
Kozin SH, Zlotolow DA. Common pediatric congenital conditions of the hand. Plast Reconstr Surg 2015; 136(2):241e-57. DOI: 10.1097/PRS.0000000000001499. PMID: 26218399.
McQuillan TJ, Hawkins JE, Ladd AL. Incidence of acute complications following surgery for syndactyly and polydactyly: an analysis of the national surgical quality improvement program database from 2012 to 2014. J Hand Surg Am 2017; 42(9):749.e1-7. http://dx.doi.org/10.1016/j.jhsa.2017.05.011
Grahn PM, Nietosvaara NN, Nietosvaara NN, Sommarhem AJ, Nietosvaara YA. New simple technique for syndactyly release. Plast Reconstr Surg-Glob Open 2020; 8(5):e2842. DOI: 10.1097/GOX.0000000000002842.
Pino PA, Zlotolow DA, Kozin SH. What's new in congenital hand surgery. J Pediatr Orthop 2020; 40(8):e753–60. DOI: 10.1097/BPO.0000000000001629
Wang AA, Hutchinson DT. Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient. J Hand Surg Eur 2019; 44(8):845–9. DOI: 10.1177/1753193419848989. Epub 2019 May 16th. PMID: 31096828.
Sullivan MA, Adkinson JM. A systematic review and comparison of outcomes following simple syndactyly reconstruction with skin grafts or a dorsal metacarpal advancement flap. J Hand Surg Am 2017; 42(1):34–40.e6. DOI: 10.1097/BPO.0000000000001629.
Mandarano-Filho LG, Bezuti MT, Akita R, Mazzer N, Barbieri CH. Congenital syndactyly: case by case analysis of 47 patients. Acta Ortop Bras 2013; 21(6):333–5. DOI: 10.1590/S1413-78522013000600007. PMID: 24453692; PMCID: PMC3874989.
Wang S, Zheng S, Li N, Feng Z, Liu Q. Dorsal hexagon local flap without skin graft for web reconstruction of congenital syndactyly. J Hand Surg Am 2020; 45(1):63.E1–9. DOI: 10.1016/j.jhsa.2019.03.009. Epub 2019 May 9th. PMID: 31079892.
Ni F, Mao H, Yang X, Zhou S, Jiang Y, Wang B. The use of an hourglass dorsal advancement flap without skin graft for congenital syndactyly. J Hand Surg Am 2015; 40(9):1748-54.e1. http://dx.doi.org/10.1016/j.jhsa.2015.04.031
Pettitt DA, Arshad Z, Mishra A, McArthur P. Apert syndrome: a consensus on the management of apert hands. Journal of Cranio-Maxillofacial Surgery 2017; 45(2): 223–31. https://doi.org/10.1016/j.jcms.2016.11.018.
Braun TL, Trost JG, Pederson WC. Syndactyly Release. Semin Plast Surg 2016; 30(4):162–70. DOI: 10.1055/s-0036-1593478. PMID: 27895538; PMCID: PMC5115922.
Le Hanneur M, Cambon-Binder A, Bachy M, Fitoussi F. Treatment of congenital syndactyly. Hand Surg Rehabil 2020; 39(3):143–53. https://doi.org/10.1016/j.hansur.2019.12.003
Oda T, Pushman AG, Chung KC. Treatment of common congenital hand conditions. Plast Reconstr Surg 2010; 126(3):121e–33. DOI: 10.1097/PRS.0b013e3181e605be. PMID: 20811188; PMCID: PMC4404786.
Yildirim C, Şentürk S, Keklikçi K, Akmaz I. Correction of syndactyly using a dorsal separated V-Y advancement flap and a volar triangular flap in adults. Ann Plast Surg 2011; 67(4):357–63. DOI: 10.1097/SAP.0b013e3181fc055a. PMID: 21301304.
Guero S. Release of partial syndactyly using a trident flap without skin grafting. J Hand Surg Eur 2020; 45(2):181–6. DOI: 10.1177/1753193419882900
Ferrari BR, Werker PMN. A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction? J Hand Surg Eur 2019; 44(3):296–303. DOI: 10.1177/1753193418808183
Lumenta DB, Kitzinger HB, Beck H, Frey M. Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J Hand Surg Am 2010; 35(8):1323–9. http://dx.doi.org/10.1016/j.jhsa.2010.04.033
Liu J, Zheng H, Chen Z, Dai X, Schilling AF, Machens HG. Dorsal plane-shaped advancement flap for the reconstruction of web space in syndactyly without skin grafting: A preliminary report. J Plast Reconstr Aesthetic Surg 2015; 68(11):e167–73. http://dx.doi.org/10.1016/j.bjps.2015.06.016
Karamese M, Akdag O, Selimoglu MN, Unal Yildiran G, Tosun Z. V-Y and rectangular flap combination for syndactyly repair. J Plast Surg Hand Surg 2016; 50(2):102–6. DOI: 10.3109/2000656X.2015.1106409.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Lavin Jawher Putris, Jalal Hamasalih Fattah (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).
