title: A Systematic Review and Comparison of Outcomes Following Simple Syndactyly Reconstruction With Skin Grafts or a Dorsal Metacarpal Advancement Flap.
abstract: OBJECTIVE
  Many techniques exist for simple syndactyly reconstruction. The most commonly used techniques involve either skin grafts or a dorsal metacarpal advancement flap. Our aim was to review and compare the outcomes of these 2 techniques systematically.
  
  
  METHODS
  We reviewed articles from PubMed, MEDLINE, EMBASE, and Google Scholar published between January 1966 and January 2016. We identified studies that reported outcomes after reconstruction of simple syndactyly using skin grafts and those using only a dorsal metacarpal advancement flap. Cases of complex syndactyly and those that were not clearly differentiated by technique or type of simple syndactyly were excluded. Outcomes were then stratified by technique and type of syndactyly (complete and incomplete).
  
  
  RESULTS
  We identified 693 articles and selected 34 for inclusion. No standardized outcome measure was uniformly applied in the examined studies. Overall, skin grafting procedures were associated with more complications (eg, flap necrosis/graft failure, contracture, web creep, hypertrophic scarring) and a greater need for revision. When stratified by subtype, patients with simple, complete syndactyly who underwent skin grafting had a significantly higher rate of hypertrophic scarring than those who underwent reconstruction with a dorsal metacarpal advancement flap.
  
  
  CONCLUSIONS
  Simple syndactyly reconstruction with a dorsal metacarpal advancement flap may lead to fewer complications than procedures using skin grafts. However, substantial limitations of currently available evidence do not allow for the recommendation of a specific technique. Future research should use a uniform reporting system for syndactyly classification and complications.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Sullivan
authors.affiliation: Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address: jadkinso@iu.edu.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Adkinson
mesh_terms: D006801:Humans; D050279:Metacarpal Bones / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D013576:Syndactyly / Q000601:surgery*
keywords: dorsal metacarpal advancement flap; skin graft; surgical flap; surgical technique; syndactyly