Dorsal Bilobed Rectangular Flap and Volar Triangular Flap with Back-Cuts in the Correction of Hand Syndactyly

Suk Joon Oh

doi:10.12790/ahm.2019.24.2.189

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Oh: Dorsal Bilobed Rectangular Flap and Volar Triangular Flap with Back-Cuts in the Correction of Hand Syndactyly

Original Article

Arch Hand Microsurg 2019;24(2):189-196.

Published online: 5 January 2019

DOI: https://doi.org/10.12790/ahm.2019.24.2.189

Dorsal Bilobed Rectangular Flap and Volar Triangular Flap with Back-Cuts in the Correction of Hand Syndactyly

Suk Joon Oh

Department of Burn and Reconstructive Surgery, Bestian Seoul Hospital, Seoul, Korea

Corresponding author: Suk Joon Oh Department of Burn and Reconstructive Surgery, Bestian Seoul Hospital, 429 Dogok-ro, Gangnam-gu, Seoul 06208, Korea TEL: +82-70-7609-9321, FAX: +82-70-7005-4233, E-mail: sjoh46@nate.com, ORCID: https://orcid.org/0000-0001-7793-6198

Received 3 December 2018 Received 11 March 2019 Accepted 4 April 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

Syndactyly is a one of the most common congenital anomalies of the hand. Each patient requires a thorough assessment of the soft-tissue and bony components within the syndactylized region. The aim of this article is to describe the exact design of the surgical procedure to prevent postoperative web creep using two volar back-cuts in syndactyly correction.

Methods:

A retrospective data review of a series of twenty-two consecutive patients who were treated with correction of congenital syndactyly of the hand was conducted. Total patients number was 22. Web separation was performed in 44 webs among a total of 55 webs. This surgical technique was inserting small bilobed rectangular flaps into the volar back-cut defects on both sides, and longer dorsal rectangular flap than the previous surgical technique. Follow-up patients assessed the occurrence of patients that required secondary surgery due to web creep and patients of other sequels.

Results:

Total separations of syndactyly of 22 patients who were corrected primarily (40 webs) and secondarily (4 webs) after treatment at other hospitals. There was no postoperative web creep during follow-up. Sequels with different color matches of full-thickness skin graft, angulations (3 patients), and ankylosis (1 patient) were due to the underlying bone and joint structure. Vascular and nerve injuries were absent.

Conclusion:

Reconstructing a hand with syndactyly can be complicated and is fraught with potential pitfalls. Careful planning and meticulous surgical techniques with this surgical technique can minimize potential errors and allow satisfac-tory separation of syndactylized digits.

Keywords: Hand, Syndactyly, Congenital anomaly

REFERENCES

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Fig. 1.

Design of dorsal rectangular flap and volar triangular flap with back-cut. (A) Rectangular flap (a-b-c-d) and distal halving line (e-f) of the dorsal side, and (B) triangular flap with back-cut (b-e-f-e-c) of the volar side of syndactyly were designed. Length of each of the lines (c’-d’, e’-e’, e’-f’, c’-e’) measured from adjacent webs of the normal side of the hand. MPJs: meta-carpophalangeal joints.

Fig. 2.

Black dotted line of the normal web area is the suture line of flaps and black line shows palmar web line across three flaps of dorsal bilobed rectangular flaps and a volar triangular flap.

Fig. 3.

Black line shows palmar web line across three flaps in early postoperative volar view after correction of the 3rd web of brachysyndactyly hand.

Fig. 4.

A syndactyly of the right 1st web in bilateral cleft hands of a case 11. (A) Preoperative volar view. (B) Preoperative dorsal view. (C) Preoperative X-ray finding. (D) Preoperative angiogram of the right hand with disturbed palmar arch of the artery. (E) Postoperative volar view after two staged corrections of the syndactyly and cleft hand. (F) Postoperative dorsal view.

Fig. 5.

A complicated syndactyly of the right 3rd web of a case 19. (A) Preoperative dorsal view. (B) Preoperative X-ray finding. (C) Intraoperative view after division of fused proximal, middle phalangeal bones, and soft-tissue. Exposed proximal phalangeal joints covered with flaps, and pulleys restored with divided pulley of middle and ring fingers. (D) Postoperative dorsal view 22 years after surgery. (E) Postoperative X-ray finding of undergrowth and malrotation of middle and ring fingers. PIPJs: proximal interphalangeal joints.

Table 1.

Summary of patients

Case No.	Sex	Age (mo)	Syndactyly webs		Types of syndactyly		Associated anomaly	Operation of webs		Results (FU, mo)
Case No.	Sex	Age (mo)	Right	Left	Incomplete	Complete	Associated anomaly	Right	Left	Results (FU, mo)
1	M	12		1, 2, 3, 4	Complex		BD		2, 4, 1, 3	Excellent (12)
2	F	180	4	4		Simple	Both HP	4	4	Excellent (9)
3	M	12	3, 4	4		Simple	Both HP	4, 3	4	Excellent (12)
4	M	348	3	3	Secondary, Simple			3	3	Excellent (12)
5	M	24	4	4		Simple	Both HP	4	4	Fair (6)
6	M	36	3	3		Secondary, Simple		3	3	Excellent (12)
7	M	72	3	3		Simple		3	3	Excellent (8)
8	M	12	4	4		Simple	Both HP			Fair (6)
9	M	48		2, 4	Complex		CBS		2, 4	Fair (48)
10	F	192	2			Complex	HP, 4th MF	2		Fair (6)
11	M	48	1	1		Complex	Both CH, Rt 4th, Lt 2nd MF	1	1	Good (10)
12	M	24	3	3	Simple			3	3	Excellent (7)
13	M	24	1, 2, 3	1, 2, 3, 4		Complex	Both BD	2	1, 4	Good (12)
14	F	176	3	3		Secondary, Simple	Both BD	3		Excellent (12)
15	F	7	2, 3	2, 3	Simple (Rt 2nd web & Lt 3rd web)	Complicate (Rt 3rd web, Lt 2nd web)	Both BD	3		Excellent (8)
16	F	36		2, 3, 4	Simple		BD		2, 4	Excellent (6)
17	M	4		1, 2	Simple				1, 2	Excellent (9)
18	M	36	2, 3		Simple		BD, PS	2, 3		Excellent (12)
19	M	24	3			Complicate	CH, symphalngism	3		Fair (264)
20	M	12	2			Complex	CBS	2		Fair (3)
21	F	3	2, 3, 4	2, 3, 4		Complex	Both CBS	2, 4	2, 3	Fair (12)
22	M	2		3	Simple				3	Excellent (12)

M: male, F: female, FU: follow-up, BD: brachydactyly, HP: hypoplasia, CBS: constriction band syndrome, MF: missing finger, CH: cleft hand, Rt: right, Lt: left, PS: Poland syndrome.

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