The Modified V-Y Dorsal Metacarpal Flap for Repair of Syndactyly Without Skin Graft

Author(s): Hsu VM, Smartt J Jr., Chang B

Source: Plast Reconstr Surg 125:225-32, 2010.

Summary:
The authors performed a retrospective review of 28 syndactylies undergoing reconstruction without skin grafting due to the use of the V-Y dorsal metacarpal flap for web space repair leaving the dorsal skin normally used for the web space flap available for digital skin coverage.  Of 28 syndactylies separated with follow-up of greater than 1 year (average 4.2 years), 25 were simple incomplete and 3 simple complete. Only 2 patients experienced complications consisting of web creep of 5 mm (1 patient) and DIP radial angulation unrelated to the original operation.
 
The authors demonstrate that recruitment of vascularized orsal hand skin leaves more skin for digital coverage and can be reliably performed with little morbidity and a low rate of web creep.  However, this technique was used very selectively in that most patients were those with incomplete syndactylies.  In fact, of the patients not included in the study, only 18 percent of patients with simple complete syndactyly in their practice had this operation performed, the results of which 3 are reported.  Other techniques for minimizing the use of skin grafts are available.  One which they did not discuss but can be used on complete syndactylies is the trilobed flap (Niranjan NS, et al., Long-term results of primary syndactyly correction by the trilobed flap technique. Br J Plast Surg 58:14-21, 2005).  However, for incomplete syndactylies this appears to be a robust and reliable reconstructive option which is relatively complication free in this medium sized series.