Congenital Differences-Case: Syndactyly Example

Case: Syndactyly Example

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This document discusses the technique of using dorsal flaps with skin grafts for the treatment of complete syndactyly, specifically focusing on the avoidance of grafts on the ring finger. The dorsal commissure flap is used and starts at the level of the metacarpal heads, including two-thirds of the length of the proximal phalanx. Additionally, a palmar rectangular flap is created to resurface the proximal area of a digit adjacent to the commissure. Buck-Gramcko flaps are utilized for lateral nail fold reconstruction to avoid the need for a composite flap. <br /><br />The technique involves starting with a thin dorsal commissure flap and getting thicker at the base, using sharp dissection and bipolar tools. Buck-Gramcko flaps are developed in a proximal to distal manner, with defatting of the flaps as they are created. The volar neurovascular structures are visualized from the dorsal side and the length and location of the volar flaps are checked after elevation of the dorsal flaps. Digital separation is facilitated by lateral spreading of the digits, with sharp and blunt dissection of fascial bands, preservation of the inter-volar plate ligament, and division of back nerves.<br /><br />The document also mentions the identification of the bifurcation between the common and proper neurovascular structures, defatting of the adjacent sides of the separated digits before insetting the flaps, and the closure of the commissure flap first using gut sutures. The remaining gaps are closed with full-thickness skin grafts, with options for graft sites including the volar wrist crease, forearm, groin, and foreskin. The post-op course involves minimizing shear and hematoma by using Adaptik maltese cross and fluffs between fingers, as well as protecting the hand in a long-arm mitten cast for three weeks.

Keywords

dorsal flaps

skin grafts

complete syndactyly

ring finger

dorsal commissure flap

Buck-Gramcko flaps

digital separation

volar neurovascular structures

full-thickness skin grafts

post-op course