Comparative study of 2 commissural dorsal flap techniques for the treatment of congenital syndactyly.

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Details: By PubMed; Pediatrics; 21 September 2013

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Comparative study of 2 commissural dorsal flap techniques for the treatment of congenital syndactyly.

J Pediatr Orthop. 2013 Mar;33(2):197-204

Authors: Mallet C, Ilharreborde B, Jehanno P, Litzelmann E, Valenti P, Mazda K, Penneçot GF, Fitoussi F

Abstract
BACKGROUND: Many commissural reconstruction techniques have been described for the treatment of syndactyly. This study is the first to compare long-term results of 2 commissural dorsal flap procedures (T-flap and omega-flap).
METHODS: Fifty-nine web-spaces in 39 patients, operated on between 1991 and 2008, were retrospectively analyzed. Thirty-six T-flap and 23 omega-flap procedures were performed using full-thickness skin graft in every case for digital resurfacing. Factors that could affect the long-term outcome were collected, including development of web-creep, clinodactyly, and flexion contracture. Patients were reviewed with a mean follow-up of 5 years and 8 months.

RESULTS: Preoperative complexity of syndactyly influenced the development of clinodactyly and flexion contracture. Among the patients who developed clinodactyly, 96% had surgery for complex syndactyly. No difference was found between the 2 flap methods concerning digital deformation and mobility. However, web-creep occurred more frequently after T-flap than after omega-flap procedures (17% vs. 5%).
CONCLUSIONS: The combination of either dorsal commissural T-flaps or omega-flaps with full-thickness graft to resurface digits is a reliable technique for the treatment of syndactyly with satisfactory functional and cosmetic results. Long-term results are not influenced by the type of flap. Nevertheless, the omega-flap technique, using 2 triangular lateral-palmar flaps, avoids use of skin graft to cover lateral-palmar aspects of the new commissure, consequently reducing the incidence of web-creep. In cases of syndactyly, the primary prognostic factor is whether the patient has simple or complex syndactyly. In complex syndactyly, the risk of long-term unfavorable results is higher. When complex complicated syndactyly is involved, postoperative complication rates increase.
LEVEL OF EVIDENCE: Level III.

PMID: 23389576 [PubMed - indexed for MEDLINE]

Last Updated: 22 September 2013

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Comparative study of 2 commissural dorsal flap techniques for the treatment of congenital syndactyly.

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