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:

IV