From 2011 to 2012, nearly two hundred cases of juxtaposition of fingers and toes were treated surgically (the number of webs was even higher, in some cases four webs were surgically separated at one time), mostly with V-tip flaps, with excellent results. In particular, the postoperative appearance of the soft tissue finger webs is very good, and the finger webs are almost the same as the natural ones (see my other articles on finger webs), but the only disadvantage is that the finger webs need skin implants on both sides, even for a small area.
The color of the skin after implantation is darker than normal skin, and this color difference is more obvious on the palm side than on the back side of the hand, because the palm skin is whiter. In the second half of last year, care was taken to place the implant site as close to the dorsal side of the finger as possible, so that the color difference defect of the implant would be minimized. One of the parents of a baby operated with this method said that this Chinese New Year, no one in a large family of relatives could tell that the child’s hand was post-parallel finger surgery, including the aunt who had washed the child’s hand.
Although the old method has very mature and stable results, but in view of the fact that there are always a number of parents who have expressed the hope that the parallel fingers are not implanted. From the second half of last year, a modification of the parallel finger (toe) finger (toe) Pu-formation was gradually implemented. Based on my original V-tip flap and the advantages of the pentagonal flap of Director Gao Weiyang, we designed a new finger (toe) webbing method, the biplane flap, which made it possible to separate the parallel fingers and toes without skin implants.
However, in order to be cautious, the method was started on the parallel toes of the feet, and it has been applied in the parallel toe separation of the feet for nearly half a year, and now it has gained more mature experience and has been fully applied in the parallel finger separation of the hands since this year.
However, it should be noted that the application of this method does not allow all the syndactyly to be done without implants. In particular, I emphasize the aesthetic appearance of the finger and will not force the wound to be closed for the sake of non-implantation, which may cause postoperative wound scar contracture and finger flexion. Small skin grafting is usually needed at the end of the finger, especially after the separation of the finger with tightly attached nails. However, since the root of the finger usually does not require skin grafting, the skin area can be very small. Instead of choosing the groin, a small piece of skin can be taken from the ulnar side of the wrist or the inner ankle of the foot, and the wound can be sutured to match the natural skin pattern of the wrist and ankle, so that the scar is not easily visible. Also, fingers that have curvature themselves are not suitable for this method.
It is important to emphasize that I can’t say that the results are significantly better than the old method I used. Although there is no skin graft or a small area of skin graft, there is an additional dorsal scar, which is more pronounced on the dorsal side of the finger and toe. This is actually a common problem with all current techniques of juxtaposed finger separation without skin grafting, which is the inevitable result of using the dorsal skin to form the finger web and to close the trauma on the lateral side of the finger. Thus, there are advantages and disadvantages to each technique, skin grafting or no skin grafting.
In the juxtaposition of the foot, I would recommend the new method without or with less skin grafting because the scar on the foot is not conspicuous. However, for the hand syndactyly, since both methods have their own advantages and disadvantages, I will inform the parents and let them decide on their own choice. I do both methods.
Here are the results of some cases without skin implants, because the article of the new method is to be published, the situation of the back of the hand is not posted as much as possible.
Case 1: The child, male, 2 years old, had 2 and 3 juxtaposed fingers with 4 and 5 fingers absent.
He has a wide postoperative webbing, no implant at all, and is awaiting parental follow-up. (This child’s parents are working outside and promised to follow up when they return home in the Spring Festival of 2014)
Case 2, child, male, 7 months.
There was no bleeding at all under the intraoperative blood repellent. After the surgery was completed, the repellent band was released and there was a little bleeding from the wound, but it was obvious that the blood supply of the flap was very good after the suture was closed. Immediately after the surgery, the finger webs were deliberately made wider, and the webs were normal after the wound was slightly contracted later. We are also waiting for parental follow-up.
At 2.5 months after surgery, the first follow-up visit was made, the scar was still obvious, and Conrad was prescribed for topical application. In my experience, the dorsal flap design was too large and the dorsal scar was long. This has been improved in the recent cases.
Case 3, child, male, now just 4 years old. He has undergone two surgeries. This case is used to illustrate the comparison of implant color difference and dorsal finger scar.
Preoperative 2, 3, 4 incomplete juxtaposition of fingers
After the first surgery to separate 2,3 and 3 parallel fingers, it was the oldest double triangular flap method to form the finger webs, and skin was implanted on both sides of the finger webs (this case will be operated in one operation, not in several times).
After 1.5 months of postoperative surgery, the scar on the dorsal surface of the finger was still obvious, and the scar would become white and soft after the topical application of Conrad’s skin to lighten the scar, but it would still be visible.
Case 4, bipedal flap shaping finger web has another advantage that multiple fingers can be operated in parallel in one operation.
http://www.handsurgery.cn/forum.php?mod=viewthread&tid=47586&extra=page%3D2%26filter%3Dtypeid%26typeid%3D49%26typeid%3D49
The double-wing flap has been introduced in my congress presentation on complex fasciculation syndrome at the 12th Hand Surgery Conference in Wenzhou at the end of May 2013. The article on bipedal flap separation and finger was also pitched. Therefore, I can now post some more cases.
Case 5
A child, male, with 3 and 4 incomplete juxtaposed fingers on both hands, with bipedal flap formed finger webs and no skin implants
Less than 2 months postoperatively, the scar will slowly lighten later
left hand
right hand
The above case still has some shortcomings, the dorsal flap design is too large and the dorsal scar is too long, which has been improved in the recent cases. This child had some other problems with skin flaking, which did not affect the surgery.
The dorsal finger wound length is slightly reduced, and the key is that the flap is made smaller, the wound tension is lower, and the scar is lighter.
The wound is closed without skin grafting at all and the blood supply to each flap is also good.
This was done only half a month ago, out-of-town child, waiting for parents to send post-op pictures.
3 months after the surgery, the parents sent pictures, and in fact, this child’s recovery was not too smooth, that skin flap was really a hand fungus, and it took longer for the wound to heal from the dressing change. After this lesson, all subsequent children with dandruff will call the dermatology department to take a look.
3 months after surgery, the scar proliferation period, not yet started to soften, later the scar becomes white and soft is not so obvious
The prerequisite of no implantation of the juxtaposed fingers is that the soft tissue between the juxtaposed fingers is loose, especially the skin of the distal fingers is not tightly connected, because the bifid flap can only solve the root of the fingers without implantation, if the distal fingers are tightly connected, usually the distal fingers will have implants. Parents should fatten up their babies and rub the skin between the fingers to make them looser, so that the chance of no implantation will be higher.
Update 2013.10.30
Recently, the bifid flap was modified, the flap was made smaller, and the dorsal incision at the root of the finger was shortened to half of the original size, and the result is really good!
The child, half a year old, left 3 and 4 juxtaposed fingers, with more lax skin, was in good condition.
The dorsal incision at the root of the finger was already short, about 4 mm
The finger web is wide and will be just right as it will be slightly reduced after surgery. The operation was completed in a little over an hour, and there was not a drop of blood during the operation.
3 months after the operation, the parents sent the picture, barely see ah
After
This is another child’s post-op.
The following is this child’s, because the condition itself is good, the skin is loose, combined with bipedal flaps without skin implants, so this effect is good, the skin is loose, the wound tension is not big, the natural scar is not heavy, more than 2 months after surgery, it is the scar growth period, the scar is not obvious.
These pictures above should be coated with Conradipine, an anti-scarring drug.
The following pictures were taken a few days after the above pictures were taken by the parents at my request, and then changed to a colorful background. I hope the parents will send pictures again after six months of post-op without the medicine.
This child is comparable to the child with only a small piece of skin implant on both sides of the finger web that I mentioned in another juxtaposition article.
Of course, there are many children who cannot achieve this result, because many children are not as good as this child.
But I also hope that children with conditions similar to this child can be treated with the same results, so I would like to promote this flap nationwide and let more doctors master this technique.