Parallel finger surgery, to implant or not to implant, is a question that has stumped thousands of parents. Why skin grafting? When the fingers are joined together, no matter what method is used to separate the fingers, the area of skin that opens up is not enough to cover the fingers and the webbing, and there will definitely be a skin (soft tissue) defect on the opposite edge of the webbing. It cannot be left “open”, can it? For this reason, the dorsal palm flap or the adjacent dorsal flap can be designed to cover it, but for some complex completely syndactyly, there is still a part of the defect that can not be repaired by the flap, so ultimately it is necessary to implant the skin in order to achieve the purpose of the surgery. Currently, skin grafting is preferred in the lower abdomen and groin because these areas are more hidden, have a larger margin of access, and have reliable skin quality. Despite the maturity of the skin grafting procedure, there is still one problem that should not be ignored, and that is the many “pitfalls” associated with skin removal. How so? First of all, skin grafting can cause scarring of the donor area due to “trauma”, and how can a child who already has a finger defect cause new trauma. Secondly, skin grafts can cause hyperpigmentation of the skin in the recipient area, as well as a decrease in sensation and function, and can even lead to the risk of necrosis of the graft. These are the key points that parents of children with syndactyly have repeatedly struggled with. For this reason, the “No Implant for Parallel Fingers” program was developed. The “No Implant Surgery for Syndactyly” is an artificial dermis-induced dermal implant-free syndactyly split finger surgery. During the surgery, artificial dermal material is applied to the trauma area to induce the skin to grow on its own, avoiding the need to take skin from other parts of the body and greatly reducing the trauma of the surgery. At the same time, the duration of the surgical operation is significantly shorter than that of skin grafting, and the child’s anesthesia time is also reduced as a result. Most importantly, the new skin induced by artificial dermis is closer to the native skin of the human body, and therefore does not suffer from hyperpigmentation and is more aesthetically pleasing. At the same time, finger sensation and function are superior to skin grafting. What type of syndactyly, simple or complex, can be “implant-free”? Artificial dermal induction is suitable for all types of syndactyly, and is more effective in the treatment of complex syndactyly. Let’s take an example. This is a complete complicated syndactyly. As you can see from the preoperative photo, the child has a bony connection between the syndactyly and the two fingernails are joined together at the end of the finger. One of the problems we have when doing a syndactyly in a case like this is that the distal end of the phalanx faces the exposed bone. It is difficult to perform flap repair at the distal end due to the relatively small amount of skin, and it is difficult for a skin graft to survive on the bone. Therefore, we used an artificial dermal induction without implantation. By artificial dermal induction, the healthy surrounding tissues are allowed to grow slowly toward the traumatic tissue, and better healing is achieved without sacrificing the skin in other areas. The surgery went smoothly and successfully. The child’s affected finger recovered well after the surgery, and the length of the finger and joint function were very good, and the parents were very satisfied with the results of the surgery.