Dorsal VY Advancement Flap: A Technique for Repair of Simple Syndactyly that Facilitates Direct Closure

Elwakeel, Helmy S.; Kholosy, Hassan M.; Abouarab, Mohamed H.

doi:10.21608/ejprs.2021.173845

Dorsal VY Advancement Flap: A Technique for Repair of Simple Syndactyly that Facilitates Direct Closure

Document Type : Original Article

Authors

The Department of Plastic Surgery Unit, Faculty of Medicine, Alexandria University, Egypt

10.21608/ejprs.2021.173845

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.

Keywords

Main Subjects

References

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