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Syndactyly Web Space Reconstruction Using the Tapered M-to-V Flap: A Single Surgeon, 30-year Experience.
Alexander F. Mericli, M.D., Jonathan S. Black, M.D., Raymond F. Morgan, M.D..
University of Virginia, Charlottesville, VA, USA.

Purpose
The ideal syndactyly web space (WS) reconstruction should be reliable, durable, easily reproducible, and adaptable to the spectrum of the disorder. We hypothesize that the tapered “M-to-V” flap fits many of these criteria (Figure 1). Superior features include ease of intraoperative adjustment, minimized scar contracture due to the incorporation of a z-plasty along the palmodigital crease, and improved color match.
Methods
The tapered M-to-V flap is a unique method of syndactyly WS reconstruction pioneered by the senior author. Demographics and patient characteristics were recorded. Complications included flap loss, graft loss, deformity recurrence (“creep”), infection, and restricted range of motion.
Results
138 WS were reconstructed in 93 patients. There were 89 primary congenital hand and 32 foot syndactylies; 4 patients had an acquired syndactyly; there were 13 secondary reconstructions. There was a total complication rate of 14%. The most common complication was WS creep, secondary to partial skin graft loss (12 WS, 9%); there were no total flap losses; only 9 WS (6%) required any surgical revision. Univariate analysis did not reveal any factor to be predictive of an elevated complication rate. The average length of follow up was 2.6 years (6 months - 26 years).
Conclusions
Several design features contribute to this flap’s superiority. The M-to-V flap persists over time and is associated with a low complication rate in a variety of clinical scenarios.


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