Multiple digit symbrachydactyly web space reconstruction using dorsal contiguous gullwing flaps
10.3760/cma.j.cn114453-20210825-00363
- VernacularTitle:连续双翼皮瓣成形指蹼一期分离短指并指畸形的灵活应用
- Author:
Xiaofei TIAN
1
;
Jun XIAO
;
Tianwu LI
Author Information
1. 重庆医科大学附属儿童医院烧伤整形外科 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室，重庆 400014
- Keywords:
Hand deformities, congenital;
Symbrachydactyly;
Poland syndrome;
Contiguous gullwing flaps
- From:
Chinese Journal of Plastic Surgery
2022;38(12):1350-1357
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the safety and effectiveness of modified contiguous gullwing flaps for web space reconstruction of multiple digit symbrachydactyly.Methods:A retrospective analysis was performed on patients of multiple digit symbrachydactyly who underwent surgery in the Children’s Hospital of Chongqing Medical University from January 2018 to January 2021. The modified dorsal contiguous gullwing flaps were designed to reconstruct the web space without leaving a gap between the distal ends of each flap. After separating the fused digits with a zigzag incision, most of the wounds could be closed directly. For a few cases of the skin defect, the skin grafts harvested from the palmer-ulnar site of the ipsilateral wrist was used to cover the wound. In 2 cases, the modified design and the original design were used in combination. Intraoperative findings of the digital proper arteries, skin grafts, operation time and the finger blood supply, and the postoperative data of wound healing grade were recorded. The results were followed up and evaluated by a modified Withey scale.Results:A total of 21 patients were enrolled, including 13 males and 8 females, ranging in age from 6 months to 6 years old with an average age of 20 months. Among them, there were 13 cases of three-fingered syndactyly and 8 cases of four-fingered syndactyly, with a total of 50 webs. Among them, 8 cases were combined with the first web stenosis or partial syndactyly. In 19 cases, the degree of syndactyly was at least the half length of fingers, and the remaining 2 cases had mild symptoms. All operations could be finished within 2 hours. During the operation, one side digital artery in 6 webspaces was ligatured owing to the bifurcation point was too distal, and the vascular perfusion was normal. Small pieces of skin grafts were used in 12 fingers, the wound healed in one stage with no wound infection, and skin graft necrosis occurred. After 3-37 months of follow-up (average of 10 months), the shape of the formed webspace was natural, and the width of the webspace at the level of the metacarpophalangeal crease was not less than one-third of the width of the finger, which was coordinated with the proportion of the palm and fingers. The depth of the webs could reach or exceed the level of the metacarpophalangeal crease. The fingers were still shorter according to the size of the palm. No secondary flexion deformity, lateral deviation deformity, and rotation deformities occurred. The appearance was acceptable to the parents and no hypertrophy scar was noticed. The score evaluated by the modified Withey scale of the follow-up cases was 0.Conclusions:Using the modified contiguous gullwing flap could separate multiple fingers symbrachydactyly in one stage operation safely without skin grafting or small-size skin grafting. The procedure is mainly indicated for those cases with tight skin syndactyly. The combined application of the modified design and the original design of the contiguous gullwing flap could be recommended for patients whose skin tension is different between the three coterminous webspaces.
