title: Linear Separation of Toe Syndactyly With Preserved Subcutaneous Vascular Network Skin Grafts.
abstract: BACKGROUND
  Conventional surgery of toe syndactyly is accomplished using a zig-zag incision and full thickness or split thickness skin grafting. However, this method has an aesthetic problem with a prominent scar on the dorsal side of the foot. The aim of the article was to investigate the efficacy of a cosmetically conscious operation for syndactylies performed using a single technique.
  
  
  METHODS
  A retrospective analysis was performed involving 66 patients with 88 syndactylic toes who presented to the department of plastic and reconstructive surgery at 1 of 3 major institutions during a 16-year period (1998-2014). Syndactylies were classified according to the affected interdigital spaces (IDSs). All cases were treated using the same method: linear skin incisions to divide the digits, triangular flaps on the dorsal and plantar sides of the foot, and preserved subcutaneous vascular network skin grafts from the medial inframalleolar region.
  
  
  RESULTS
  The most frequent type of toe syndactyly was IDS-2 (union of the second/third toes), which accounted for 59.1% (39/66) of the cases. The rates of familial anomalies were significantly different between bilateral IDS-2 (4/13) and unilateral IDS-2 (0/24) (P < 0.05, Fisher exact test). There were no severe postoperative complications, including scar contracture or keloid formation. All patients obtained sufficiently deep IDSs, and none required repeat surgery.
  
  
  CONCLUSIONS
  A straight incision minimizes the scar observed from the visible side, and preserved subcutaneous vascular network skin grafts prevent postoperative contracture of linear scar.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, National Defense Medical College Saitama; †Department of Plastic and Reconstructive Surgery, Shonai Amarume Hospital, Yamagata; ‡Department of Plastic and Reconstructive Surgery, Mito Saiseikai General Hospital; and §Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Aizawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Togashi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Haga
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sekido
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Kiyosawa
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013576:Syndactyly / Q000601:surgery*; D014034:Toes / Q000002:abnormalities* / Q000098:blood supply / Q000601:surgery; D016896:Treatment Outcome