SLR - November 2016 - Yana Akselrud
Reference: Yamashita K, Yotsuyanagi T, Yamauchi M, Sugai A, Gonda A, Kato S, Kita A. Subcutaneous Pedicle V–Y Flap for Release of Incomplete Congenital Syndactyly. J Plast Reconstr Aesthet Surg. 2016 Aug; 69(8).Scientific Literature Review
Reviewed By: Yana Akselrud, DPM
Residency Program: NYU Lutheran Medical Center
Podiatric Relevance: Congenital syndactyly is seen as soft-tissue webbing in the interspace of the digits of the hand and foot commonly complicated by bony involvement. Literature has reported a multitude of techniques utilized to separate the digits with innovative surgical intervention. Frequent de syndactyly procedures introduce the use of local flaps and skin grafting to separate the united digits. In cases of incomplete syndactyly, described as webbing proximal to the inter phalangeal joint, an innovative technique has been performed to create an interspace with the use of a pedicle V-Y flap. This procedure allows for the separation of the webbed digits and creation of an interspace with a locally harvested flap and primary skin closure of each digit. This technique is offered as a simplified surgical alternative to harvesting grafts from an alternate site and from introducing synthetic skin replacements to the newly separated digits.
Methods: Ten patients (eight hands and three feet) with congenital syndactyly were identified. These patients were noted to have incomplete syndactyly, defined as soft-tissue webbing proximal to the interphalangeal joint of the digit. A triangular flap was drawn on the affected interspace with a line extending from the proximal apex into the metacarpo/metatarsophalangeal joint. The triangle was then incised and carefully undermined so as to preserve the vasculature of the entire flap. The triangular flap was then moved proximally and sutured in to create an interspace. If adjustments needed to be made post translation of the flap, the straight incision at the proximal apex was then extended and manipulated. The skin on the medial and lateral aspects of the digits was reapproximated primarily in a zig-zag fashion.
Results: Results of the study indicated that good correction was noted in all patients with the use of the V-Y pedicle with a one-year follow-up. The study found that there was no postoperative limitation of mobility. A mild soft-tissue contracture was noted in one of the cases but with overall good results. It was found that average procedure time was slightly more than one hour, and the average hospital stay was 15 days.
Conclusions: The goal of this study was to produce an interspace between two conjoined digits using a simplified surgical technique that provided aesthetically pleasing results. Although strictly limited for a partial soft-tissue syndactyly, this procedure allowed for the correction of the deformity with the use of a locally harvested flap. Other surgical alternatives to this procedure have previously included various skin plasties and flaps, but it has been found that many of these have restricted mobility and require more extensive dissection. In this case, the use of the pedicle V-Y flap can be harvested from the same surgical site and allows for the preservation of vascular supply to the flap with minimal undermining. This simplified procedure allows for the surgeon to make use of the patient's excess interspace skin to create a functional interspace with no restrictions in mobility.