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This study describes the use of a bilobed flap for reconstruction of web spaces in the treatment of syndactyly release also that may avoid the use of skin grafting in incomplet syndactyly. Proximally based dorsal rectangular skin flap is the most common procedure for reconstructing web spaces (1). However, with this method, the linear scar along the palmar border of the web space may lead to secondary contracture and web creep, and modifications have been recommended for this procedure (2). The present technique was developed based on a concept for the beneficial use of the dorsal hand skin by lowering the need of skin graft. The flap was designed for web formation on the dorsal skin of the proximal phalanx and dorsal skin of the hand.

We present 5 syndactyly repairs with bilobed flap (Figure 1, 2). There were no intraoperative complications and no cases of neurovascular compromise. There were also no incidences of flap loss or ischemic injury. In all patients, the donor site of the dorsal flap healed with acceptable scar formation (Figure 3).

Traditional surgical approaches to syndactyly repair have used flaps from the dorsum of the involved fingers and dorsal and palmar interdigitating flaps (3, 4). However, these flaps are dependent on skin from syndactylic fingers already insufficient in surface area (3). This study reported favorable outcomes obtained using a bilobed flap for the surgical correction of syndactyly. In the repair of syndactyly, long-term stability of the newly created web space is best achieved when lined with well-vascularized native skin (5). This technique decreases the graft need, and also it provides sindactyly repair without skin graft in incomplet syndactylies. Although one of the disadvantages of this technique is the formation of a scar on the dorsal side of a treated finger and hand, the scar found in the present study was acceptable and resulted in no significant cosmetic problems after surgery.

Figure 1. Preoperative view and flap planning.

Figure 2. İntraoperative view.

Figure 3. Postoperative 1,5 months.