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Improved “Bell-Bottom” Flap Surgical Technique for Syndactyly without Skin Graft

Matsumine, Hajime M.D.; Yoshinaga, Yuichiro M.D.; Fujiwara, Osamu M.D.; Sasaki, Ryo D.D.S., Ph.D.; Takeuchi, Masaki M.D., Ph.D.; Sakurai, Hiroyuki M.D., Ph.D.

Plastic and Reconstructive Surgery: November 2011 - Volume 128 - Issue 5 - p 504e–509e
doi: 10.1097/PRS.0b013e31822b696d
Hand/Peripheral Nerve: Original Articles

Background: This study describes the use of a modified “bell-bottom” flap for treatment of partial syndactyly release that may avoid the use of skin grafting.

Methods: A retrospective review of this procedure was performed for 12 interdigital space reconstructions. Patients were aged 1 to 5 years 6 months. The mean follow-up period was 24 months. The operations were performed to avoid skin grafting. The flap was designed in the narrow-spaced and fused interdigital region of syndactyly for preventing postoperative scar contracture and web formation.

Results: Surgery was completed without skin grafting in all cases. The use of a modified flap allowed the construction of interdigital spaces with sufficient width, providing satisfactory cosmetic outcomes. No partial necrosis or complications were observed. No web formation, elevation of the interdigital space, or limited range of joint motion caused by contracture was observed during the 2-year follow-up period, and no secondary correction was needed.

Conclusion: The present surgical technique may be a new surgical option for web release in which fingers are fused at a level lower than the midpoint between the proximal and distal interphalangeal joints.


Chiba, Tokyo, and Kagosima, Japan

From the Department of Plastic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University; the Institute of Advanced Biomedical Engineering and Science and the Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University; and the Department of Plastic and Reconstructive Surgery, Kagoshima City Hospital.

Received for publication February 9, 2011; accepted May 6, 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Hajime Matsumine, M.D.; Department of Plastic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, 477-96 Owada-shinden, Yachiyo-shi, Chiba 276-8524, Japan,

©2011American Society of Plastic Surgeons