Correction of Syndactyly using Pentagonal Flap with Minimal Skin Graft.

Bae, Byoung Man; Eo, Su Rak; Kim, In Kyu; Koh, Sung Hoon; Jones, Neil F

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2007;34(1):64-69.
Published online January 1, 2007.

Correction of Syndactyly using Pentagonal Flap with Minimal Skin Graft.

Byoung Man Bae, Su Rak Eo, In Kyu Kim, Sung Hoon Koh, Neil F Jones

¹Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Korea.
²Department of Plastic and Reconstructive Surgery, Dongguk University International Hospital, Gyeonggi-do, Korea. sreo@duih.org
³UCLA Medical Center, USA.

Abstract

PURPOSE
The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. METHODS: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area.
RESULTS
Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss.
CONCLUSION
As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.

Keywords: Syndactyly; Web space; Pentagonal flap

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