title: Single-Stage Separation of 3- and 4-Finger Incomplete Simple Syndactyly With Contiguous Gull Wing Flaps: A Technique to Minimize or Avoid Skin Grafting.
abstract: OBJECTIVE
  Staged separation of 3- and 4-finger syndactyly is commonly performed owing to concerns about vascular supply to the central digit and availability of flap skin. We performed single-stage separation of patients with incomplete syndactyly of multiple digits with adjacent contiguous dorsal gullwing flaps and avoided skin grafts in the majority of cases.
  
  
  METHODS
  Seventy-four webs of 31 patients with more than 2-finger incomplete syndactyly were included. Median age at surgical separation was 12 months (range, 5-123 months). All cases were incomplete syndactyly that did not extend to the fingernail level, with no bony involvement. A dorsal gullwing flap was used for all cases, which reconstructed the interdigital webs and partly covered the lateral side of the proximal phalanx. The technique relies on perfusion of the flap through the dorsal metacarpal artery perforator to aid flap mobility and double radial and ulnar z-plasties on each side of the flap to aid flap advancement. Skin grafts were needed if there were any remaining skin defects.
  
  
  RESULTS
  In 30 of 31 cases, a single-stage procedure was accomplished. One case was staged owing to abnormal digital arterial anatomy found on exploration. No skin graft was required in 21 out of 31 patients (67.7%). Median postoperative follow-up was 12 months (range, 6-36 months). All finger web depths were normal or slightly deepened.
  
  
  CONCLUSIONS
  One-stage separation for 3- and 4-finger syndactyly with a dorsal gullwing flap is feasible and safe as long as at least 1 proper digital artery is preserved in each finger. The need for skin grafting is minimized.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics, Chongqing, China.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Tian
authors.affiliation: Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics, Chongqing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics, Chongqing, China.
authors.forename: Tianwu
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics, Chongqing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics, Chongqing, China.
authors.forename: Qiu
authors.initials: Q
authors.lastname: Lin
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL. Electronic address: harveychim@yahoo.com.
authors.forename: Harvey
authors.initials: H
authors.lastname: Chim
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005385:Fingers / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016038:Skin Transplantation; D013524:Surgical Flaps / Q000098:blood supply / Q000601:surgery*; D013576:Syndactyly / Q000601:surgery*
keywords: Poland syndrome; Syndactyly; congenital hand; synbrachydactyly