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Aesthetic Comparison of Two Different Types of Web-Space Reconstruction for Finger Syndactyly

Yuan, Frank, M.D.; Zhong, Lin, M.D., M.P.H.; Chung, Kevin C., M.D., M.S.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 963–971
doi: 10.1097/PRS.0000000000004798
Hand/Peripheral Nerve: Original Articles
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Coding Perspective

Background: Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. The authors’ study compares the long-term aesthetic outcomes of these two flap techniques.

Methods: Forty-five patients were included in the authors’ study. The methods of reconstruction used were a dorsally based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting. Eighteen independent raters completed a visual analogue scale and a unique classification scale to subjectively assess aesthetic outcomes. The authors used univariate analyses to determine which variables significantly influenced the outcome score. The authors then used multivariable regression models to compare the two flap types.

Results: Dorsally based rectangular flaps with skin graft had statistically significantly better visual analogue scale scores and greater odds of receiving an “excellent” rating compared with dorsal pentagonal advancement flaps.

Conclusions: Despite the use of skin grafting, with its associated donor-site morbidity, dorsal rectangular flaps may offer better overall aesthetic outcomes for patients. Future comparative studies should incorporate functional and patient-reported outcomes to better assess the optimal reconstruction type.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Coding Perspective for this Article is on Page 971.

Ann Arbor, Mich.

From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School; and the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System.

Received for publication October 25, 2017; accepted February 2, 2018.

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

Kevin C. Chung, M.D., M.S., Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-5340, kecchung@med.umich.edu

©2018American Society of Plastic Surgeons