Abstract
An aesthetically pleasing fingertip is an important but often under evaluated goal in syndactyly release. We assessed the aesthetic fingertip outcome in 26 patients with complete syndactylies, with a total of 84 separated digits, using a four-grade scale based on the quality of the lateral nail fold, nail plate definition, symmetry and pulp fullness. Fingertips with complete simple syndactylies released with the use of full-thickness skin grafts achieved a significantly better aesthetic result then fingertips with complete complex syndactylies released with the use of Buck-Gramcko pulp flaps. Fingertips involved in complex syndactylies achieved significantly better aesthetic results when reconstructed using Buck-Gramcko flaps in comparison with those reconstructed with full-thickness skin grafts. We recommend the use of Buck-Gramcko flaps in complete complex syndactylies, while reserve the traditional zig-zag and full-thickness skin graft closure for cases of complete simple syndactylies. We also propose a grading system for the aesthetic outcome of the fingertip following syndactyly release.
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