title: Comparative study of 2 commissural dorsal flap techniques for the treatment of congenital syndactyly.
abstract: BACKGROUND
  Many commissural reconstruction techniques have been described for the treatment of syndactyly. This study is the first to compare long-term results of 2 commissural dorsal flap procedures (T-flap and omega-flap).
  
  
  METHODS
  Fifty-nine web-spaces in 39 patients, operated on between 1991 and 2008, were retrospectively analyzed. Thirty-six T-flap and 23 omega-flap procedures were performed using full-thickness skin graft in every case for digital resurfacing. Factors that could affect the long-term outcome were collected, including development of web-creep, clinodactyly, and flexion contracture. Patients were reviewed with a mean follow-up of 5 years and 8 months.
  
  
  RESULTS
  Preoperative complexity of syndactyly influenced the development of clinodactyly and flexion contracture. Among the patients who developed clinodactyly, 96% had surgery for complex syndactyly. No difference was found between the 2 flap methods concerning digital deformation and mobility. However, web-creep occurred more frequently after T-flap than after omega-flap procedures (17% vs. 5%).
  
  
  CONCLUSIONS
  The combination of either dorsal commissural T-flaps or omega-flaps with full-thickness graft to resurface digits is a reliable technique for the treatment of syndactyly with satisfactory functional and cosmetic results. Long-term results are not influenced by the type of flap. Nevertheless, the omega-flap technique, using 2 triangular lateral-palmar flaps, avoids use of skin graft to cover lateral-palmar aspects of the new commissure, consequently reducing the incidence of web-creep. In cases of syndactyly, the primary prognostic factor is whether the patient has simple or complex syndactyly. In complex syndactyly, the risk of long-term unfavorable results is higher. When complex complicated syndactyly is involved, postoperative complication rates increase.
  
  
  METHODS
  Level III.
authors: Department of Pediatric Orthopedics, Robert Debré Hospital, Paris, France. cindy.mallet@rdb.aphp.fr
authors: Cindy
authors: C
authors: Mallet
authors: Brice
authors: B
authors: Ilharreborde
authors: Pascal
authors: P
authors: Jehanno
authors: Estelle
authors: E
authors: Litzelmann
authors: Philippe
authors: P
authors: Valenti
authors: Keyvan
authors: K
authors: Mazda
authors: Georges-François
authors: GF
authors: Penneçot
authors: Franck
authors: F
authors: Fitoussi
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006228:Hand Deformities, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013576:Syndactyly / Q000601:surgery*; D016896:Treatment Outcome