This complex syndactyly was difficult to perform, firstly, the toe structure was confusing, the first, second, third and fourth toes were clearly shaped but structurally disorganized, meanwhile the distal fifth toe was completely missing and the proximal phalanx was encased in the skin, it appeared to be only four toes, but in fact there were five. Secondly, the toe webbing was disorganized, with no clear and well-defined toe webbing, and the surrounding skin structure was suboptimal. For this surgical operation, we not only need to separate the syndactyly, but also to allow a better and complete reconstruction of the toe webbing. This requires preoperative design, careful intraoperative exploration, and then adjustments to the surgical plan based on actual findings. Inevitably, there will be a large amount of skin loss after such a merging and splitting of the toes, and the repair of the skin loss needs to be carefully designed. Some of the skin defects can be covered by localized flap transfer, but the child will have some bone exposure, so how to cover the bone exposure? How to cover the exposed bone? Is the flap alone enough? This is a major problem that we need to consider and solve during the operation. During the actual operation, we basically realized the preoperative design plan, and covered all the traumas with flaps where we could use flap transfer, and where flap transfer couldn’t cover the traumas, we covered them with artificial dermis-induced skin-less implantation. The child is now recovering well and we hope for a speedy recovery.