Reconstruction finger web with dorsal two wing-shaped advancement flap for the treatment of congenital syndactyly_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENG Deliang , ZHANG Lijun , WANG Qiang , LÜ Min , DUAN Honghao , HU Leimin ,  LIANG Xiaoju

The First Department of Hand Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiao Tong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

LIANG Xiaoju, Email: 458558850@qq.com

Keywords：

Congenital syndactyly; finger web reconstruction; surgical flaps

DOI：

10.7507/1002-1892.201809012

Video：

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Objective To discuss the effectiveness of using dorsal two wing-shaped advancement flap to reconstruct finger web for treatment of congenital syndactyly.Methods Between August 2014 and August 2017, 30 cases of congenital syndactyly were treated, including 18 males and 12 females with an average age of 2.5 years (range, 1.5-5 years). Eight cases were of bilateral hands syndactyly and 22 cases of single hand syndactyly. There were 39 webs of syndactyly (including 1 case of syndactyly of middle finger, ring finger, and little finger). Among them, 11 webs were complete and 28 webs were incomplete. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle was designed and was just sewed up with an anchor-shaped incision at the palm. Distal end of fingers were separated by serrated flap and were sutured after removal of fatty tissue. In 11 cases with tight skin connection, the defect area at lateral and distal end of fingers was repaired by small pieces of full-thickness skin graft.Results All the flaps survived completely after operation, and no flap necrosis occurred. The skin grafts on the distal side of the finger survived and the wound healed by first intension. All 30 cases were followed up 6-12 months, with an average of 9 months. Postoperative flexion and extension function of fingers were good, and the web depth and width were normal. At last follow-up, according to the Swanson et al. standard, 20 fingers were graded as excellent, 8 as good, and 2 as fair, with an excellent and good rate of 93.3%.Conclusion The effectiveness of using dorsal two wing-shaped advancement flap to reconstruction finger web for treatment of congenital syndactyly is satisfactory.

Citation： CHENG Deliang, ZHANG Lijun, WANG Qiang, LÜ Min, DUAN Honghao, HU Leimin, LIANG Xiaoju. Reconstruction finger web with dorsal two wing-shaped advancement flap for the treatment of congenital syndactyly. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(2): 195-198. doi: 10.7507/1002-1892.201809012 Copy

1.	顾玉东, 王澍寰, 侍德. 手外科手术学. 上海: 复旦大学出版社, 2007: 787-788.
2.	Loréa P, Coessens BC. Evolution of surgical techniques for skin releases in the treatment of simple congenital syndactyly: a review. Eur J Plast Surg, 2001, 24: 275-281.
3.	Mei H, Zhu G, He R, et al. The preliminary outcome of syndactyly management in children with a new external seperation device. J Pediatr Orthop B, 2015, 24(1): 56-62.
4.	Jordan D, Hindocha S, Dhital M, et al. The epidemiology genetics and future management of syndactyly. Open Orthop J, 2012, 6: 14-27.
5.	Ni F, Mao H, Yang X, et al. The use of an hourglass dorsal advancement flap without skin graft for congenital syndactyly. J Hand Surg (Am), 2015, 40(9): 1748-1754.
6.	Lumenta DB, Kitzinger HB, Beek H, et al. Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J Hand Surg (Am), 2010, 35(8): 1323-1329.
7.	Swanson AB, Hagert CG, Swanson GD. Evaluation of impairment of hand function. J Hand Surg (Am), 1983, 8(5 Pt 2): 709-722.
8.	陶忠生, 冯亚高, 田帅男, 等. 三叶草状皮瓣重建先天性并指指蹼. 实用骨科杂志, 2011, 17(10): 921-923.
9.	吴守成, 宋建良, 姚建民, 等. M-W 皮瓣在指 (趾) 蹼重建中的临床应用. 中华手外科杂志, 2002, 18(2): 101-102.
10.	Lewis RC, Nordyke MD, Duncan KH. Web space reconstruction with a M-V flap. J Hand Surg (Am), 1988, 13(1): 40-43.
11.	惠自兵, 樊东力, 王佳琦, 等. 反 M-V 皮瓣指蹼重建术在并指畸形矫正中的应用. 中国美容整形外科杂志, 2011, 22(1): 11-13.
12.	高伟阳, 王安远, 蒋良福, 等. 指背五边形皮瓣重建先天性并指指蹼. 中华手外科杂志, 2010, 26(4): 193-194.
13.	刘育杰, 丁小珩, 张宏勋, 等. 掌背侧菱形推进皮瓣在先天性并指治疗中的应用. 中华手外科杂志, 2011, 27(4): 211-213.
14.	刘焕龙, 王增涛, 张文龙, 等. 掌背穿支皮瓣滑移术在并指畸形指蹼重建中的应用. 中华整形外科杂志, 2015, 31(3): 195-197.
15.	田晓菲, 邱林, 傅跃先, 等. 双翼皮瓣成形指蹼修复先天性并指畸形. 中华整形外科杂志, 2014, 30(2): 96-98.
16.	董延召, 刘福云, 郭永成, 等. 不需植皮的双翼皮瓣治疗并指畸形. 中华整形外科杂志, 2018, 34(9): 735-738.
17.	宋修军, 潘达德, 于洪文, 等. M-A 指蹼成形治疗先天性并指畸形. 中华手外科杂志, 1995, (增刊): 34-36.
18.	肖斌, 刘毅, 张鲜英. 先天性并指畸形分离术后指坏死一例. 中华手外科杂志, 2005, 21(1): 64.

1. 顾玉东, 王澍寰, 侍德. 手外科手术学. 上海: 复旦大学出版社, 2007: 787-788.
2. Loréa P, Coessens BC. Evolution of surgical techniques for skin releases in the treatment of simple congenital syndactyly: a review. Eur J Plast Surg, 2001, 24: 275-281.
3. Mei H, Zhu G, He R, et al. The preliminary outcome of syndactyly management in children with a new external seperation device. J Pediatr Orthop B, 2015, 24(1): 56-62.
4. Jordan D, Hindocha S, Dhital M, et al. The epidemiology genetics and future management of syndactyly. Open Orthop J, 2012, 6: 14-27.
5. Ni F, Mao H, Yang X, et al. The use of an hourglass dorsal advancement flap without skin graft for congenital syndactyly. J Hand Surg (Am), 2015, 40(9): 1748-1754.
6. Lumenta DB, Kitzinger HB, Beek H, et al. Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J Hand Surg (Am), 2010, 35(8): 1323-1329.
7. Swanson AB, Hagert CG, Swanson GD. Evaluation of impairment of hand function. J Hand Surg (Am), 1983, 8(5 Pt 2): 709-722.
8. 陶忠生, 冯亚高, 田帅男, 等. 三叶草状皮瓣重建先天性并指指蹼. 实用骨科杂志, 2011, 17(10): 921-923.
9. 吴守成, 宋建良, 姚建民, 等. M-W 皮瓣在指 (趾) 蹼重建中的临床应用. 中华手外科杂志, 2002, 18(2): 101-102.
10. Lewis RC, Nordyke MD, Duncan KH. Web space reconstruction with a M-V flap. J Hand Surg (Am), 1988, 13(1): 40-43.
11. 惠自兵, 樊东力, 王佳琦, 等. 反 M-V 皮瓣指蹼重建术在并指畸形矫正中的应用. 中国美容整形外科杂志, 2011, 22(1): 11-13.
12. 高伟阳, 王安远, 蒋良福, 等. 指背五边形皮瓣重建先天性并指指蹼. 中华手外科杂志, 2010, 26(4): 193-194.
13. 刘育杰, 丁小珩, 张宏勋, 等. 掌背侧菱形推进皮瓣在先天性并指治疗中的应用. 中华手外科杂志, 2011, 27(4): 211-213.
14. 刘焕龙, 王增涛, 张文龙, 等. 掌背穿支皮瓣滑移术在并指畸形指蹼重建中的应用. 中华整形外科杂志, 2015, 31(3): 195-197.
15. 田晓菲, 邱林, 傅跃先, 等. 双翼皮瓣成形指蹼修复先天性并指畸形. 中华整形外科杂志, 2014, 30(2): 96-98.
16. 董延召, 刘福云, 郭永成, 等. 不需植皮的双翼皮瓣治疗并指畸形. 中华整形外科杂志, 2018, 34(9): 735-738.
17. 宋修军, 潘达德, 于洪文, 等. M-A 指蹼成形治疗先天性并指畸形. 中华手外科杂志, 1995, (增刊): 34-36.
18. 肖斌, 刘毅, 张鲜英. 先天性并指畸形分离术后指坏死一例. 中华手外科杂志, 2005, 21(1): 64.

Chinese Journal of Reparative and Reconstructive Surgery

Reconstruction finger web with dorsal two wing-shaped advancement flap for the treatment of congenital syndactyly

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