title: The Use of an Hourglass Dorsal Advancement Flap Without Skin Graft for Congenital Syndactyly.
abstract: OBJECTIVE
  To investigate the efficacy of congenital syndactyly correction with flexion crease and web space reconstruction using a dorsal hourglass-shaped flap without skin graft.
  
  
  METHODS
  We studied 116 syndactylies in 96 patients. Surgical strategy focused on flexion crease and web space reconstruction using an hourglass-shaped dorsal advancement flap. We assessed for flap necrosis, height and width of the webs according to the criterion of D'Arcangelo, and total active digital motion compared with the normal side. Scar formation was measured by the Vancouver Scar Scale score. We also administered a parent-based satisfactory questionnaire.
  
  
  RESULTS
  Mean follow-up was 4.2 years. All syndactylies could be corrected without skin grafts. Dorsal flap plasty facilitated the reconstruction of commissure with a slope of 45° in an hourglass shape. Two cases encountered partial flap loss but healed without surgical intervention. There were no recurrences. According to the criterion of D'Arcangelo, the height and width of 98 webs were good, 16 webs were fair, and 2 webs were poor. Mean total active motion of the index, middle, ring, and little fingers of the affected side was 160, 158, 153, and 150, respectively. Mean Vancouver Scar Scale score was 1.4. After surgery, all parents were satisfied with the appearance and function of the separated fingers.
  
  
  CONCLUSIONS
  Reconstruction of the flexion crease and web space simultaneously with an hourglass-shaped dorsal advancement flap can achieve good aesthetic and functional outcomes.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Ni
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Hailei
authors.initials: H
authors.lastname: Mao
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Shengbo
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yongkang
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: wangbin1766@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
mesh_terms: D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000453:epidemiology; D003286:Contracture / Q000453:epidemiology; D004954:Esthetics; D005260:Female; D005385:Fingers / Q000002:abnormalities*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000637:transplantation*; D011795:Surveys and Questionnaires; D013576:Syndactyly / Q000601:surgery*; D016896:Treatment Outcome
keywords: Congenital syndactyly; flexion crease; hourglass-shaped dorsal advancement flap; web space