Elwakeel, H., Kholosy, H., Abouarab, M. (2021). Dorsal VY Advancement Flap: A Technique for Repair of Simple Syndactyly that Facilitates Direct Closure. The Egyptian Journal of Plastic and Reconstructive Surgery, 45(2), 81-88. doi: 10.21608/ejprs.2021.173845
Helmy S. Elwakeel; Hassan M. Kholosy; Mohamed H. Abouarab. "Dorsal VY Advancement Flap: A Technique for Repair of Simple Syndactyly that Facilitates Direct Closure". The Egyptian Journal of Plastic and Reconstructive Surgery, 45, 2, 2021, 81-88. doi: 10.21608/ejprs.2021.173845
Elwakeel, H., Kholosy, H., Abouarab, M. (2021). 'Dorsal VY Advancement Flap: A Technique for Repair of Simple Syndactyly that Facilitates Direct Closure', The Egyptian Journal of Plastic and Reconstructive Surgery, 45(2), pp. 81-88. doi: 10.21608/ejprs.2021.173845
Elwakeel, H., Kholosy, H., Abouarab, M. Dorsal VY Advancement Flap: A Technique for Repair of Simple Syndactyly that Facilitates Direct Closure. The Egyptian Journal of Plastic and Reconstructive Surgery, 2021; 45(2): 81-88. doi: 10.21608/ejprs.2021.173845
Dorsal VY Advancement Flap: A Technique for Repair of Simple Syndactyly that Facilitates Direct Closure
The Department of Plastic Surgery Unit, Faculty of Medicine, Alexandria University, Egypt
Abstract
Background: Over the past few decades in a trial to avoid skin grafting and its drawbacks in syndactyly repair, graftless techniques of syndactyly release were advocated with promising success. Two principles typically underly those techniques: Importation of more dorsal hand skin by appropriate flap design and/or finger defatting, this permitted web space reconstruction with direct closure of the fingers. In the present study, a graftless syndactyly repair technique using dorsal VY advancement flap for web space reconstruction combined with defatting of the separated digits is investigated. Patients and Methods: The technique was used in repair of 15 syndactylized web spaces (10 simple incomplete & 5 simple complete syndactyly) in 7 cases, aged between 12-24 month at first surgery. Dorsal VY advancement flap from the hand dorsum just proximal to the neo web space was advanced to resurface the web based on the dorsal intermetacarpal artery perforator. Fingers were separated by straight line incision bisecting the fused digits, this was closed directly after carful finger defatting, resulting in straight line midlateral finger scar. Results: The technique achieved adequate web space without the need for skin graft in all operated cases. Neither flap necrosis nor web creep was seen in this series with average of 14 months follow up. Midlateral finger scars were cosmetically and functionally accepted. No finger contracture was noticed. Flap donor site (dorsal hand) scar was less forgiving with average of 5 out of 10 on VAS score assessment. Conclusion: The technique is simple and reliable for repair of simple syndactyly without the need of a skin graft. It is easy to perform in relatively short time.
Goldfarb C.A.: Congenital hand differences. J. Hand. Surg. Am., 34 (7): 1351-1356, 2009. 2- Kozin S.H. and Zlotolow D.A.: Common pediatric congenital conditions of the hand. Plast. Reconstr. Surg., 136 (2): 241e-257e, 2015. 3- Malik S.: Syndactyly: Phenotypes, genetics, and current classification. Eur. J. Hum. Genet., 20 (8): 817-824, 2012. 4- Green D.P., Hotchkiss R.N., Pederson W.C. and Wolfe S.W.: Green's Operative Hand Surgery. Vol. 2. 7th ed. Philadelphia: Elsevier PA, pp. 1217-1232, 2017. 5- Netscher D.T. and Baumholtz M.A.: Treatment of congenital upper extremity problems. Plast. Reconstr. Surg., 119 (5): 101e-129e, 2007. 6- Oda T., Pushman A.G. and Chung K.C.: Treatment of common congenital hand conditions. Plast. Reconstr. Surg., 126 (3): 121e-133e, 2010. 7- Lumenta D.B., Kitzinger H.B., Beck H. and Frey M.: Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J. Hand Surg. Am., 35 (8): 1323-1329, 2010. 8- Cronin T.D.: Syndactylism: Results of zig-zag incision to prevent postoperative contracture. Plast. Reconstr. Surg., 18: 460-468, 1956. 9- Bauer T.B., Tondra J.M. and Trusler H.M.: Technical modification in repair of syndactylism. Plast. Reconstr. Surg., 17: 385-92, 1956. 10- Flatt A.E.: Treatment of syndactylism. Plast. Reconstr. Surg., 29: 336-41, 1962. 11- Brown P.M.: Syndactyly-A Review and Long-Term Results. Hand, os-9 (1): 16-27, 1977. 12- Toledo L.C. and Ger E.: Evaluation of the operative treatment of syndactyly. The Journal of Hand Surgery, 4 (6): 556-564, 1979. 13- Niranjan N.S. and De Carpentier J.: A new technique for the division of syndactyly. Eur. J. Plast. Surg., 13 (3): 101-104, 1990. 14- Ekerot L.: Syndactyly correction without skin-grafting. J. Hand Surg. [Br.], 21 (3): 330-337, 1996. 15- Vickers D. and Donnelly W.: Corrective surgery of syndactyly without the use of skin grafts. Hand Surg., 1: 203- 208, 1996. 16- Sherif M.M.: V-Y dorsal metacarpal flap: A new technique for the correction of syndactyly without skin graft. Plast. Reconstr. Surg., 101 (7): 1861-6, 1998. 17- Sharma R.K., Tuli P., Makkar S.S. and Parashar A.: Endof- skin grafts in syndactyly release: Description of a new flap for web space resurfacing and primary closure of finger defects. Hand (NY), 4 (1): 29-34, 2009. 18- Aydın A. and Ozden B.C.: Dorsal Metacarpal Island Flap in Syndactyly Treatment. Ann. Plast. Surg., 52: 43-48, 2004. 19- Yildirim C., Sentürk S., Keklikçi K. and Akmaz I.: Correction of syndactyly using a dorsal separated V-Y advancement flap and a volar triangular flap in adults. Ann. Plast. Surg., 67: 357-63, 2011. 20- Matsumine H., Yoshinaga Y., Fujiwara O., Sasaki R., Takeuchi M. and Sakurai H.: Improved “bell-bottom” flap surgical technique for syndactyly without skin graft. Plast. Reconstr. Surg., 128 (5): 504e-509e, 2011. 21- Teoh L.C. and Lee J.Y.: Dorsal pentagonal island flap: A technique of web reconstruction for syndactyly that facilitates direct closure. Hand Surg., 9: 245-52, 2004. 22- Wafa A.M.: Hourglass dorsal metacarpal island flap: A new design for syndactylized web reconstruction. J. Hand Surg. Am., 33 (6): 905-8, 2008. 23- Hsu V.M., Smartt J.M. Jr. and Chang B.: The modified V-Y dorsal metacarpal flap for repair of syndactyly without skin graft. Plast. Reconstr. Surg., 125 (1): 225-232, 2010. 24- Liu J., Zheng H., Chen Z., Dai X., Schilling A.F. and Machens H-G.: Dorsal plane shaped advancement flap for the reconstruction of web space in syndactyly without skin grafting: A preliminary report, J. Plast. Reconstr. Aesthet. Surg., Nov., 68 (11): e167-73, 2015. 25- Greuse M. and Coessens B.C.: Congenital syndactyly: Defatting facilitates closure without skin graft. J. Hand Surg. (Am.), 26: 589-594, 2001. 26- Quaba A.A. and Davison P.M.: The distally based dorsal hand flap. Br. J. Plast. Surg., 43: 28-39, 1990. 27- Yuan F1, Zhong L. and Chung K.C.: Aesthetic Comparison of Two Different Types of Web-Space Reconstruction for Finger Syndactyly. Plast. Reconstr. Surg., 142 (4): 963- 971, 2018. 28- Sullivan M.A. and Adkinson J.M.: A systematic review and comparison of outcomes following simple syndactyly reconstruction with skin grafts or a dorsal metacarpal advancement flap. J. Hand Surg. Am., 42: 34-40, 2017
View on SCiNiTO
Top