Correction of Syndactyly with Modified M Flap and Minimal Skin Graft

Chin, Sang Woo; Jo, Dong In; Oh, Jung Keun; Hwang, Weon Jung; Ahn, Hee Chang; Kim, Jeong Tae

Abstract

The principles of syndactyly correction are well established at the present time, such as the creation of dorsal and/or palmar rectangular flaps designed to reconstruct the web space, the utilization of zigzag incisions along the full length of the syndactyly to avoid contraction that might follow a straight line closure, and skin grafts to cover raw surfaces. Although numerous operative techniques based on the above principles have been introduced, most of them required skin graft inevitably because the separated fingers have a greater surface area than the syndactylized digits. The grafted hyperpigmented skin makes the finger and toe noticeable and the multiple small pieces of skin graft themselves are time-consuming procedure, and the grafted skin near the base of fingers could cause future recurrence or contracture. So we tried to develop a modified technique which could minimize the case of skin grafts by using regional skin as much as possible. A new method that we present here is a combination of first, a diverging M flap from syndactilized digital skin for commissure, second, an island flap from ventral or dorsal surface of the hand and foot to cover the raw surface at the base of divided digit, and third, the removal of fat tissue around the neurovascular bundles of the fingers for primary closure with flaps without tension at least in one digit. 11 patients composed of 5 hands and 16 feet syndactylies were operated for their correction with newly modified technique for 4 years. A long term follow-up indicates that gratifying functional and aesthetic results could be achieved without recurrences or disabling contractures of the interdigital space. This easy and rapid technique can be recommended for the correction of syndactyly because of its advantage of minimizing the problems appeared in cases by previous methods.