Advertisement

Aesthetic Plastic Surgery

, Volume 35, Issue 4, pp 530–537 | Cite as

Dorsal Pentagonal Local Flap: A New Technique of Web Reconstruction for Syndactyly Without Skin Graft

  • Weiyang Gao
  • Hede YanEmail author
  • Feng Zhang
  • Liangfu Jiang
  • Anyuan Wang
  • Jingquan Yang
  • Feiya Zhou
Original Article

Abstract

Background

Many techniques for web space reconstruction have been described over the years. However, few techniques are completely satisfactory in terms of cosmetic requirement and functional recovery due to scar contracture, web creep, or conspicuous scarring resulting from skin grafting or additional incisions on the dorsal palm. Based on the anatomy of the dorsal metacarpal artery, the authors describe a local pentagonal advancement flap including perforators of the dorsal metacarpal artery to optimize web reconstruction and facilitate direct closure in the syndactyly treatment.

Methods

A local dorsal pentagonal advancement flap was used to reconstruct 17 web spaces in ten patients. The skin of the syndactylized fingers was brought to the web space from the dorsum of the two adjacent syndactylized fingers to cover the web area, facilitating a skin graft-free procedure for web reconstruction.

Results

All 17 web releases were successfully reconstructed. During the follow-up period of 23–35 months, the appearance of all the reconstructed webs was similar to that of the adjacent normal webs, and all the patients had full functional recovery. No case of web creep was reported during this period, and none of the patients required a secondary operation.

Conclusion

The dorsal pentagonal advancement flap is a dependable flap based on known perforators from the dorsal metacarpal arteries. The reported technique is a simple and effective technique for the correction of simple syndactyly and is especially suitable for reconstruction of two webs in multiple syndactyly simultaneously, avoiding the need for skin grafts and leaving acceptable scars on the dorsum of the hand for web reconstruction.

Keywords

Local Flap Pentagonal flap Syndactyly Web reconstruction 

Notes

Conflict of interest

None.

References

  1. 1.
    Sherif MM (1998) V-Y dorsal metacarpal flap: a new technique for the correction of syndactyly without skin graft. Plast Reconstr Surg 101:1861–1866PubMedCrossRefGoogle Scholar
  2. 2.
    Wafa AM (2008) Hourglass dorsal metacarpal island flap: a new design for syndactylized web reconstruction. J Hand Surg Am 33:905–908PubMedCrossRefGoogle Scholar
  3. 3.
    Baier TB, Tondra JM, Trusler HM (1956) Technical modification in repair of syndactylism. Plast Reconstr Surg 17:385–392CrossRefGoogle Scholar
  4. 4.
    Cronin TD (1956) Syndactylism: results of zig-zag incision to prevent postoperative contracture. Plast Reconstr Surg 18:460–468CrossRefGoogle Scholar
  5. 5.
    Keret D, Ger E (1987) Evaluation of a uniform operative technique to treat syndactyly. J Hand Surg Am 12(5 Pt 1):727–729PubMedGoogle Scholar
  6. 6.
    Smith RJ (1981) Syndactyly. In: Lamb DW, Kuczynski K (eds) The Practice of Hand Surgery, 1st edn. Oxford, Blackwell Scientific, pp 313–329Google Scholar
  7. 7.
    Chang LY, Yang JY, Wei FC (1994) Reverse dorsometacarpal flap in digits and web space reconstruction. Ann Plast Surg 33:281–289PubMedCrossRefGoogle Scholar
  8. 8.
    Ekerot L (1996) Syndactyly correction without skin grafting. J Hand Surg Br 21:330–337PubMedCrossRefGoogle Scholar
  9. 9.
    Quaba AA, Davison PM (1990) The distally based dorsal hand flap. Br J Plast Surg 43:28–39PubMedCrossRefGoogle Scholar
  10. 10.
    Aydin A, Ozden BC (2004) Dorsal metacarpal island flap in syndactyly treatment. Ann Plast Surg 52:43–48PubMedCrossRefGoogle Scholar
  11. 11.
    Frick L, Fraisse B, Wavreille G, Fron D, Martinot V (2008) Results of surgical treatment in simple syndactily using a commissural dorsal flap: About 54 procedures. Chir Main 27:76–82PubMedCrossRefGoogle Scholar
  12. 12.
    Toledo LC, Errol G (1979) Evaluation of the operative treatment of syndactyly. J Hand Surg 4:556–564Google Scholar
  13. 13.
    Upton J (1990) Congenital anomalies of the hand and forearm. In: McCarthy JG (ed) Plastic Surgery, vol 8. WB Saunders Co, Philadelphia, pp 5213–5398Google Scholar
  14. 14.
    Moss ALH, Foucher G (1990) Syndactyly: Can web creep be avoided? J Hand Surg 15B:193–200Google Scholar
  15. 15.
    Percival NJ, Sykes PJ (1989) Syndactyly: a review of the factors which influence surgical treatment. J Hand Surg 14B:196–200Google Scholar
  16. 16.
    Ekerot L (1999) Correction of syndactyly: advantages with nongrafting technique and the use of absorbable skin sutures. Scand J Plast Reconstr Hand Surg 33:427–431CrossRefGoogle Scholar
  17. 17.
    Greuse M, Coessens BC (2001) Congenital syndactyly: defatting facilitates closure without skin graft. J Hand Surg 26A:589–594Google Scholar
  18. 18.
    Teoh LC, Lee JY (2004) Dorsal pentagonal island flap: a technique of web reconstruction for syndactyly that facilitates direct closure. Hand Surg 9:245–252PubMedCrossRefGoogle Scholar
  19. 19.
    Beldame J, Havet E, Auquit-Auckbur I, Lefebvre B, Mure JP, Duparc F (2008) Arterial anatomical basis of the dorsal digito-metacarpal flap for long fingers. Surg Radiol Anat 30:429–435PubMedCrossRefGoogle Scholar
  20. 20.
    Percival NJ, Sykes PJ (1989) Syndactyly: a review of the factors which influence surgical treatment. J Hand Surg Br 14:196–200PubMedCrossRefGoogle Scholar
  21. 21.
    Smith PJ, Harrison SH (1982) The “seagull” flap for syndactyly. Br J Plast Surg 35:390–393PubMedGoogle Scholar
  22. 22.
    Uzunismail A (1988) Utility of the “seagull” flap for unoperated simple complete syndactyly in adults. Br J Plast Surg 41:548–550PubMedCrossRefGoogle Scholar
  23. 23.
    Niranjan NS, De Carpentier J (1990) A new technique for the division of syndactyly. Eur J Plast Surg 13:101–104CrossRefGoogle Scholar
  24. 24.
    Niranjan NS, Azad SM, Fleming AN, Liew SH (2005) Long-term results of primary syndactyly correction by the trilobed flap technique. Br J Plast Surg 58:14–21PubMedCrossRefGoogle Scholar
  25. 25.
    Uzunismail A, Findik H, Beyhan G (2006) “Trilobed flap” and “the seagull flap” for syndactyly. J Plast Reconstr Aesthet Surg 59:309PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2011

Authors and Affiliations

  • Weiyang Gao
    • 1
  • Hede Yan
    • 1
    Email author
  • Feng Zhang
    • 2
  • Liangfu Jiang
    • 1
  • Anyuan Wang
    • 1
  • Jingquan Yang
    • 1
  • Feiya Zhou
    • 1
  1. 1.Department of Orthopedic Surgery, Division of Plastic and Hand SurgeryThe Second Affiliated Hospital of Wenzhou Medical CollegeWenzhouChina
  2. 2.Division of Plastic SurgeryUniversity of Mississippi Medical CenterJacksonUSA

Personalised recommendations