Classification And Surgical Treatment Of Postoperative Deformity Of Simple Syndactyly

Objective: To evaluate the clinical performance of postoperative deformity after the release of simple syndactyly,and to discuss the corresponding method for repair.Method: Clinical data of 25 children with postoperative deformity after simple syndactyly releasing,included the presence or absence of skin graft during primary surgery and postoperative infection,as well as the clinical performance of postoperative deformity,were reviewed retrospectively.The common types of postoperative deformity,and surgical protocol for secondary surgery were summarized.Moreover,follow-up study on appearance,wound healing and function restoration after secondary surgery was conducted.Result: The common deformities of simple syndactyly can be summarized in four main categories: web deformity,finger deformity,nail deformity and skin color difference.Out of 25 patients,17 underwent skin grafting during primary surgery and 4 developed infection after surgery.During the reparative surgery,for web deformity,Z-plasty technique were used to deepen finger webs in 2 cases,and the dorsal rectangular flap were used in 3 cases,the double wing flap were used in 11 cases to reconstructweb space.For finger deformity,in all cases,most of scar skin was reserved and released by multiple Z-plasty incisions to extend and straighten the fingers,while full-thickness skin grafting was employed if lacking of enough skin to close wound.For nail deformity,using the adjacent flap pushed forward to wrap the nail margin.For skin color difference,using z-plasty incision to broke the large piece of dark skin into small one and remove the overly dark skin as much as possible.According to follow-up survey,the finger webs in all cases reached both normal depth and width after reconstruction,the effected fingers could straighten almost and the difference in skin color reduced partly.However,few improvement was seen in nail deformities.Conclusion: The occurrence of postoperative deformity of simple syndactyly may be related to the tight stitching(should have skin grafting)and the wound infection during primary surgery.The flaps for construction of web space,especially double wing flap,can be used widely in all kinds of web deformities,which could result in excellent web shape.The area of skin grafting can be reduced dramatically by reserving softened scar skin and using multiple Z-plasty technique in the repair of finger contracture,and the skin with deep pigment should be removed as much as possible when adjusting flaps.The patients at last can reach a good finger straightness and normal web space with few contracture after repair,and the skin color difference can also be significantly reduced.However,it is difficult to repair the deformity of nai.