The role of skin grafts in the treatment of hand syndactyly in childhood

Abstract

Syndactyly of the hand is a frequent congenital anomaly with remarkable diversity. Medical community has been concerned about its treatment since the 19th century and many skin graft repair techniques have been proposed. There is, however, a strong reflection on their value. Between 2007 and 2016, 38 cases of hand syndactyly were treated in our clinic, in 25 children with an average age of 2.4 years. Twelve of these deformities were unilateral and 13 were bilateral. All cases were surgically repaired. Finger separation was done at the 3rd interdigital web space in 24 hands and at the 4th interdigital web space in 14 hands. In thirty-two cases syndactyly was simple and in 6 complex, while in 26 cases syndactyly was complete and in 12 incomplete. After finger separation, a free skin graft from the flexor surface of the wrist joint was used to cover the skin defects of one complex and 12 simple deformities. The abdominal area was preferred as a skin graft donor area in 14 simple and 5 complex deformity cases. In 6 cases of simple incomplete syndactyly, free skin graft repair was not required. In the follow-up which ranged from 6 months to 4 years, the results were generally considered satisfactory and all hands had excellent functionality. However, in 4 patients (15.8%), a slight extension of the newly formed interdigital web creep was noted, regardless of the graft donor area and the result was considered fair. In 4 hands (10.5%), where superficial inflammation of soft tissue developed, the end result was good. In conclusion, full thickness skin grafts are considered necessary to cover finger separation defects. The selection of the donor area is left to the surgeon’s wish, as no significant correlation has been found with the final functional and cosmetic result. However, the use of a future technique where the use of skin grafts will not be required is under consideration.