HAND/PERIPHERAL NERVE The Modified V-Y Dorsal Metacarpal Flap for Repair of Syndactyly without Skin Graft Vivian M. Hsu, M.D. James M. Smartt, Jr., M.D. Benjamin Chang, M.D. Philadelphia, Pa. Background: Syndactyly repairs that use full-thickness skin grafts risk graft- related complications. The dorsal V-Y advancement flap offers a method of syndactyly release that can eliminate the need for full-thickness skin grafts in some cases of simple syndactyly. Methods: A retrospective case series of all patients undergoing syndactyly re- lease without skin grafting performed by the senior author (B.C.) between 1998 and 2007 was conducted. All outpatient and inpatient charts were reviewed for pertinent patient demographics and clinical outcomes, including the incidence of web creep, hypertrophic scarring, flexion contracture, infection, angulation deformity, limited range of motion, ischemia, and need for reoperation. Results: A total of 28 syndactylies were included in the study: 25 simple in- complete and three simple complete. Mean follow-up time was 4.2 years. Mean operative time was 68 minutes. Two patients (7.1 percent) experienced post- operative complications; both were corrected by subsequent revision. Conclusion: The dorsal V-Y advancement flap without skin graft is an effective method of repair primarily in simple incomplete syndactyly. (Plast. Reconstr. Surg. 125: 225, 2010.) S yndactyly is a common congenital hand de- formity, occurring with an incidence of one in every 2000 to 2500 births. 1–3 The malfor- mation is thought to result from a failure of pro- grammed cell death during weeks 6 to 8 of development. 1 This defect in embryogenesis re- sults in varying degrees of fusion of both the bony and soft tissues of the hand. Although most cases of syndactyly arise spontaneously, the deformity also exhibits an autosomal dominant pattern of inheritance with variable expressivity or reduced penetrance. 1 Syndactyly is also associated with a number of limb and craniosynostosis syndromes, including Poland and Apert syndromes. 1 The classification of syndactyly is based on the extent of skin fusion and bony involvement. Com- plete syndactyly occurs when fusion of the skin extends to the fingertips. When fusion of the two adjacent digits is shorter than the length of the fingers, the deformity is termed incomplete. In simple syndactyly, only soft-tissue components of the fingers are fused. In complex syndactyly, ad- jacent bones are fused in a side-to-side fashion. In cases of complicated syndactyly, there are some- times additional skeletal fusions and abnormal phalanges within the involved fingers. The goal for syndactyly release is to create a functional hand and incur the minimum amount of long-term morbidity. Practically speaking, this means creating a functional and aesthetically ac- ceptable web commissure using the minimum number of procedures. The evolution of the sur- gical repair of syndactyly has been well described in the literature. 1,4–6 The traditional method of repair over the past 60 years has involved the cre- ation of interdigitating flaps by means of zigzag incisions, with full-thickness skin grafts used to resurface any remaining defects. 4,6,7 Although this method of syndactyly repair has been used for decades, some practitioners believe that the in- corporation of full-thickness skin grafts into the newly created web space is problematic. For these From the Division of Plastic Surgery, The Children’s Hospital of Philadelphia, and the University of Pennsylvania Medical Center. Received for publication December 16, 2008; accepted Au- gust 3, 2009. Presented at the 87th Annual Meeting of the American Association of Plastic Surgeons, in Boston, Massachusetts, April 5 through 8, 2008. Copyright ©2009 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e3181c49686 Disclosures: None of the authors has any commer- cial associations that might pose or create a conflict of interest with information presented in this article. www.PRSJournal.com 225