Predictors of early and late complications after syndactyly release: A retrospective review of 684 cases

Abstract

Introduction:

This study aimed to identify predictors of early and late postoperative complications following syndactyly release. We analysed a series of 684 webspace releases at a paediatric tertiary care referral centre. We hypothesized that patient demographics and presentations would resemble the findings of previous reports. In addition, we hypothesized that complete or complex syndactyly would be predictive of early and late postoperative complications regardless of other demographic and presentation factors, as compared to simple or incomplete syndactyly.

Methods:

Patients 0–17 years of age at presentation with congenital hand syndactyly who underwent surgical correction were included. Outcomes of interest included early (less than 30 days) postoperative complications and late (greater than 30 days) postoperative complications, including pathologic scar formation and/or web creep.

Results:

In total, 684 web spaces from 318 patients were included. The average follow-up time was 2.2 years. The early 30 day complication rate was 12%, while the incidence of late postoperative complications was 26% with a web creep incidence of 8.8%. On regression analysis, complete syndactyly and bony involvement were predictors of early 30 day complications. Male sex and complete syndactyly were predictors of developing late postoperative complications. In a subgroup analysis of simple syndactyly cases, web creep and hypertrophic scarring were significantly higher in cases reconstructed with skin grafts compared to cases that utilized a graftless dorsal metacarpal VY island flap technique.

Conclusions:

While early postoperative complications are infrequent, one quarter of cases will develop a late postoperative complication. Complete syndactyly is a predictor of early and late postoperative complications. Reconstructing simple syndactyly with a graftless dorsal metacarpal VY island technique may lead to fewer postoperative complications.

Level of Evidence:

Keywords

Congenital hand graftless technique syndactyly syndactyly release VY island flap web creep

Get full access to this article

View all access options for this article.

References

Ahmed

Akbari

Emami

Akbari

MR.

Genetic overview of syndactyly and polydactyly. Plast Reconstr Surg Glob Open. 2017, 5: e1549.

Braun

Trost

Pederson

WC.

Syndactyly release. Semin Plast Surg. 2016, 30: 162–70.

Canizares

Feldman

Miller

Waters

Bae

DS.

Complications and cost of syndactyly reconstruction in the United States: analysis of the pediatric health information system. Hand (NY). 2017, 12: 327–34.

Chouairi

Mercier

Persing

Gabrick

Clune

Alperovich

National patterns in surgical management of syndactyly: a review of 956 cases. Hand (NY). 2020, 15: 666–73.

Dao

Shin

Billings

Oberg

Wood

VE.

Surgical treatment of congenital syndactyly of the hand. J Am Acad Orthop Surg. 2004, 12: 39–48.

Dong

Wang

The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment: a strobe compliant study. Medicine (Baltimore). 2017, 96: e7639.

Ferrari

Werker

PMN

. A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction? J Hand Surg Eur. 2019, 44: 296–303.

Flatt

AE.

The Care of Congenital Hand Anomalies, 2nd edn. St Louis, MO, Quality Medical Publishing, 1994.

Gauglitz

Korting

Pavicic

Ruzicka

Jeschke

MG.

Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011, 17: 113–25.

10.

Grabowski

Pacana

Chen

Keloid and hypertrophic scar formation, prevention, and management: standard review of abnormal scarring in orthopaedic surgery. J Am Acad Orthop Surg. 2020, 28: e408-e14.

11.

Guero

Release of partial syndactyly using a trident flap without skin grafting. J Hand Surg Eurl. 2020, 45: 181–6.

12.

Hsu

Smartt

Jr. Chang

The modified V-Y dorsal metacarpal flap for repair of syndactyly without skin graft. Plast Reconstr Surg. 2010, 125: 225–32.

13.

Hutchinson

Frenzen

SW.

Digital syndactyly release. Tech Hand Up Extrem Surg. 2010, 14: 33–7.

14.

Jordan

Hindocha

Dhital

Saleh

Khan

The epidemiology, genetics and future management of syndactyly. Open Orthop J. 2012, 6: 14–27.

15.

Kozin

Zlotolow

DA.

Common pediatric congenital conditions of the hand. Plast Reconstr Surg. 2015, 136: 241e–57e.

16.

Kurebayashi

Nakamoto

Nogueira

Faccioni

ALC

Goldenberg

Gemperli

Comparing results of syndactyly operated children younger and older than 1 year. Ann Plast Surg. 2021, 86: 635–9.

17.

Le Hanneur

Cambon-Binder

Bachy

Fitoussi

. Treatment of congenital syndactyly. Hand Surg Rehabil. 2020, 39: 143–53.

18.

Lorea

Coessens

. Evolution of surgical techniques for skin releases in the treatment of simple congenital syndactyly: a review. Eur J Plast Surg. 2001: 275–81.

19.

Malik

Syndactyly: phenotypes, genetics and current classification. Eur J Hum Genet. 2012, 20: 817–24.

20.

McQuillan

Hawkins

Ladd

AL.

Incidence of acute complications following surgery for syndactyly and polydactyly: an analysis of the national surgical quality improvement program database from 2012 to 2014. J Hand Surg Am. 2017, 42: 749 e1-e7.

21.

Mendenhall

Graham

Belardo

, et al. Skin graftless dorsal metacarpal island VY advancement flap versus dorsal rectangular flap with skin grafting in 213 simple syndactyly releases. Plast Reconstr Surg. 2025, 155: 969–81.

22.

Mericli

Black

Morgan

RF.

Syndactyly web space reconstruction using the tapered M-to-V flap: a single-surgeon, 30-year experience. J Hand Surg Am. 2015, 40: 1755–63.

23.

Meza

Iacone

Talwar

Sankar

Shah

AS.

Socioeconomic deprivation and its adverse association with adolescent fracture care compliance. JB JS Open Access. 2020, 5: e0064.

24.

Miyamoto

Nagasao

Miyamoto

Biomechanical analysis of surgical correction of syndactyly. Plast Reconstr Surg. 2010, 125: 963–8.

25.

Muzaffar

Rafols

Masson

Ezaki

Carter

PR.

Keloid formation after syndactyly reconstruction: associated conditions, prevalence, and preliminary report of a treatment method. J Hand Surg Am. 2004, 29: 201–8.

26.

Niessen

Spauwen

Schalkwijk

Kon

On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. 1999, 104: 1435–58.

27.

Papadakis

Manios

Trompoukis

Surgical treatment of polydactyly and syndactyly during the 4th century ad. Acta Chir Belg. 2019, 119: 64–5.

28.

Rowsell

Godfrey

AM.

A fortuitous donor site for full-thickness skin grafts in the correction of syndactyly. Br J Plast Surg. 1984, 37: 31–4.

29.

Sherif

MM.

V-y dorsal metacarpal flap: a new technique for the correction of syndactyly without skin graft. Plast Reconstr Surg. 1998, 101: 1861–6.

30.

Shinya

Dancing girl flap: a new flap suitable for web release. Ann Plast Surg. 1999, 43: 618–24.

31.

Singh

GK.

Area deprivation and widening inequalities in us mortality, 1969–1998. Am J Public Health. 2003, 93: 1137–43.

32.

Smith

Harrison

SH.

The ‘seagull’ flap for syndactyly. Br J Plast Surg. 1982, 35: 390–3.

33.

Sugihara

Ohura

Umeda

Surgical method for treatment of syndactyly with osseous fusion of the distal phalanges. Plast Reconstr Surg. 1991, 87: 157–64.

34.

Sullivan

Adkinson

JM.

A systematic review and comparison of outcomes following simple syndactyly reconstruction with skin grafts or a dorsal metacarpal advancement flap. J Hand Surg Am. 2017, 42: 34–40 e6.

35.

Sulser

Kalisch

Weber

DM.

Retroauricular full-thickness skin grafts in syndactyly repair: outcome and comparison with inguinal full-thickness skin grafts: retrospective (cross-sectional) study. J Plast Surg Hand Surg. 2016, 50: 281–5.

36.

Tang

Giddins

Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016, 41: 365–6.

37.

Tonkin

MA.

Failure of differentiation part I: syndactyly. Hand Clin. 2009, 25: 171–93.

38.

Wang

Hutchinson

DT.

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient. J Hand Surg Eur. 2019, 44: 845–9.

39.

Wang

Zheng

Feng

Liu

Dorsal hexagon local flap without skin graft for web reconstruction of congenital syndactyly. J Hand Surg Am. 2020, 45: 63 e1-e9.

40.

Yoon

Jones

NF.

Interdigitating rectangular flaps and dorsal pentagonal island flap for syndactyly release. J Hand Surg Am. 2019, 44: 288–95.

41.

Yuan

Zhong

Chung

KC.

Aesthetic comparison of two different types of web-space reconstruction for finger syndactyly. Plast Reconstr Surg. 2018, 142: 963–71.

42.

Yuan

Zhang

Xiao

Tian

Utilization of a newly designed asymmetric dorsal gull wing flap for the treatment of postoperative web creep after syndactyly surgery. Ann Plast Surg. 2021, 87: 518–22.