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Outcomes of the Dorsal-Volar Two-Triangular Flap Technique to Improve Contour and Appearance in 139 Preaxial Polydactyly Reconstructions
John R. Vaile, BS1, Niki K. Patel, MD, MSc1, Eliza Buttrick, BA1, Santiago E. Lopez Becerra, BA2, Sarah L. Struble, BS1, Apurva S. Shah, MD MBA1,2, Benjamin Chang, MD1,2 and Shaun D. Mendenhall, MD1,2, (1)The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

We present a dorsal-volar two-triangular flap technique to improve contour and appearance in preaxial polydactyly reconstructions. In traditional methods, an elliptical incision is typically created and upon closure, the middle portion of the flap may be taut with “dog-ears� forming on both ends. In using the dorsal-volar two-triangular flap technique, the design will allow surgeons to reduce the amount of skin in both the transverse and longitudinal direction, creating a zigzag closure versus a linear scar, which prevents scar contracture by relieving tension and improving overall contour of the reconstruction.

After IRB approval, preaxial polydactyly cases were retrospectively analyzed from a large children's hospital database, which contains the records of all the polydactyly patients treated at this institution from 2011-2022. Patients 0-17 years of age at presentation with preaxial polydactyly or thumb duplication that were surgically treated using the dorsal-volar two-triangular flap technique were included. Outcomes of interest included early (30-day) postoperative complications and late postoperative complications including contour deformity, pathologic scar formation, and scar contracture. Frequencies, proportions, and chi-square tests were used to analyze findings.

In total, 139 preaxial polydactyly reconstructions from 130 patients using the dorsal-volar, two-triangular flap method were analyzed. Median age at presentation was 0.22±1.5 years with an average follow-up of 1.5±2.1 years. The majority of patients included Wassel-Flatt types included Type II (n=38, 27.3%), Type IV (n=60, 43.2%), and Type VII (n=21, 15.1%). Early, 30-day complications were found in 15 cases (10.8%) with majority including unexpected cast changes (n=13, 9.4%) and infection (n=2, 1.4%). Late complications were found in 17 cases (12.2%) including contour irregularities with a residual prominence in 10 cases (7.2%) and scar complications in 7 cases (5%); hypertrophic scarring was found in 5 cases (3.6%), hyper- or hypopigmentation in 1 case (0.7%), and scar contracture in 1 case (0.7%).

Although future prospective studies are required to objectively assess final outcomes of outward appearance, this retrospective review using the dorsal-volar two-triangular flap in preaxial polydactyly reconstruction displays promising results in terms of improving surgical closure, scar contracture rates, and appearance.

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