Arch Hand Microsurg 2019; 24(2): 189-196  
Dorsal Bilobed Rectangular Flap and Volar Triangular Flap with Back-Cuts in the Correction of Hand Syndactyly
Suk Joon Oh
Department of Burn and Reconstructive Surgery, Bestian Seoul Hospital, Seoul, Korea
Correspondence to: Suk Joon Oh
Department of Burn and Reconstructive Surgery, Bestian Seoul Hospital, 429 Dogok-ro, Gangnam-gu, Seoul 06208, Korea
TEL: +82-70-7609-9321, FAX: +82-70-7005-4233, E-mail: sjoh46@nate.com, ORCID: https://orcid.org/0000-0001-7793-6198
Received: December 3, 2018; Revised: March 11, 2019; Accepted: April 4, 2019; Published online: June 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: Syndactyly is a one of the most common congenital anomalies of the hand. Each patient requires a thorough assessment of the soft-tissue and bony components within the syndactylized region. The aim of this article is to describe the exact design of the surgical procedure to prevent postoperative web creep using two volar back-cuts in syndactyly correction.
Methods: A retrospective data review of a series of twenty-two consecutive patients who were treated with correction of congenital syndactyly of the hand was conducted. Total patients number was 22. Web separation was performed in 44 webs among a total of 55 webs. This surgical technique was inserting small bilobed rectangular flaps into the volar back-cut defects on both sides, and longer dorsal rectangular flap than the previous surgical technique. Follow-up patients assessed the occurrence of patients that required secondary surgery due to web creep and patients of other sequels.
Results: Total separations of syndactyly of 22 patients who were corrected primarily (40 webs) and secondarily (4 webs) after treatment at other hospitals. There was no postoperative web creep during follow-up. Sequels with different color matches of full-thickness skin graft, angulations (3 patients), and ankylosis (1 patient) were due to the underlying bone and joint structure. Vascular and nerve injuries were absent.
Conclusion: Reconstructing a hand with syndactyly can be complicated and is fraught with potential pitfalls. Careful planning and meticulous surgical techniques with this surgical technique can minimize potential errors and allow satisfactory separation of syndactylized digits.
Keywords: Hand, Syndactyly, Congenital anomaly


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