Simple syndactyly reconstruction with dorsal metacarpal artery perforator-based propeller flap

Background Successful web space reconstruction is the most challenging in the treatment of syndactyly, and the choice of the ideal reconstructive technique is still controversial. The aim of the present study was to evaluate the use of the dorsal metacarpal artery perforator (DMAP) propeller flap for simple syndactyly reconstruction. Methods From May 2016 to May 2018, 14 consecutive children (8 male, 6 female) at a mean age of 5.3 years (2-7 years) with 16 syndactylous webs were included in this prospective study. They underwent web reconstruction using DMAP propeller flap. All patients had primary simple syndactyly. Simple syndactylies were incomplete in 8, complete in 6, unilateral in 12, and bilateral in 2 cases. Operative time and early post-operative complications were recorded. Objective assessment by 2 senior hand surgeons regarding web creep, the quality of scar, scar contracture, and the passive range of motion of the MCP was done. Parents' satisfaction on esthetic outcome was assessed. Results Sixteen flaps (mean size, 1.8 x 4.9 cm) were used in 14 patients. Surgery time per web space ranged from 50 to 75 min (mean, 54.9 min). All flaps survived completely except for one developed distal tip partial necrosis and treated conservatively. All donor sites healed uneventfully. One patient had a hypertrophic scar which was treated by silicone gel. Full range of motion, no web creep, no scar contracture, and 78.6% subjective cosmetic satisfaction were noted, at a mean follow-up of 25.1 months (range, 12-42 months). Conclusions DMAP propeller flap is proved to be a reliable option for simple syndactyly reconstruction. It is easily performed and versatile without the need for skin grafts. Moreover, the final results are functionally and cosmetically good. Level of evidence: Level IV, therapeutic study.