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

Hsu, Vivian M. M.D.; Smartt, James M. Jr M.D.; Chang, Benjamin M.D.

Plastic and Reconstructive Surgery: January 2010 - Volume 125 - Issue 1 - p 225-232
doi: 10.1097/PRS.0b013e3181c49686
Hand/Peripheral Nerve: Original Articles

Background: Syndactyly repairs that use full-thickness skin grafts risk graft-related complications. The dorsal V-Y advancement flap offers a method of syndactyly release that can eliminate the need for full-thickness skin grafts in some cases of simple syndactyly.

Methods: A retrospective case series of all patients undergoing syndactyly release without skin grafting performed by the senior author (B.C.) between 1998 and 2007 was conducted. All outpatient and inpatient charts were reviewed for pertinent patient demographics and clinical outcomes, including the incidence of web creep, hypertrophic scarring, flexion contracture, infection, angulation deformity, limited range of motion, ischemia, and need for reoperation.

Results: A total of 28 syndactylies were included in the study: 25 simple incomplete and three simple complete. Mean follow-up time was 4.2 years. Mean operative time was 68 minutes. Two patients (7.1 percent) experienced postoperative complications; both were corrected by subsequent revision.

Conclusion: The dorsal V-Y advancement flap without skin graft is an effective method of repair primarily in simple incomplete syndactyly.

Philadelphia, Pa.

From the Division of Plastic Surgery, The Children's Hospital of Philadelphia, and the University of Pennsylvania Medical Center.

Received for publication December 16, 2008; accepted August 3, 2009.

Presented at the 87th Annual Meeting of the American Association of Plastic Surgeons, in Boston, Massachusetts, April 5 through 8, 2008.

Disclosures: None of the authors has any commercial associations that might pose or create a conflict of interest with information presented in this article.

Benjamin Chang, M.D., Division of Plastic Surgery, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, 10 Penn Tower, Philadelphia, Pa. 19104,

©2010American Society of Plastic Surgeons