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Web Creep Reoperation Following Simple Syndactyly Release Using Full-Thickness Skin Grafts and Local Flaps
Bradley Brickman, MD
1, Connor Burke, MD
1, Cristina Isabel Rivera, MD
2, Chase Kluemper, MD
2, Maureen O'Shaughnessy, MD
2; Scott Riley, MD
3(1)University of Toledo, TOLEDO, OH, (2)University of Kentucky, Lexington, KY, (3)Orthopaedic Surgery, Shriners Hospital for Children, Lexington, KY
Introduction:Web creep following syndactyly release is a well-documented challenge, yet current studies focusing specifically on simple syndactyly remain limited. Numerous techniques, including local flaps and skin grafts, have been employed for soft tissue coverage, but prior research often lacks adequate sample sizes and long-term follow-up to accurately assess web creep and associated reoperation rates. One proposed advantage of full-thickness skin grafts (FTSG) is the reduction of skin tension during closure, potentially decreasing the risk of postoperative web creep. This study aimed to compare outcomes in regard to web creep between skin graft-sparing local flaps (LFs) and full-thickness skin grafts (FTSG) after simple syndactyly release.
Material and Methods:A single-institution retrospective review was conducted of pediatric patients identified using CPT codes 26560 and 26561 from 2006 to 2024. Inclusion criteria included patients under 18 years of age undergoing release of simple syndactyly-complete or incomplete-with at least two years of clinical follow-up. Variables collected included patient demographics, age at surgery, syndactyly characteristics, web space involvement, follow-up duration, presence of web creep, and need for reoperation.
Results:A total of 46 patients comprising 66 web commissures (32 LF, 34 FTSG) were included in the data analysis with an average length of follow up of 7.2 ± 3.8 years. There were no significant differences in age at initial surgery, sex, race, hand, location of web spaces, or length of follow-up between groups. Web creep developed in 59% of cases, with similar rates between LF (59.4%) and FTSG (58.8%) cohorts (
p = 1.00). No significant associations were found between web creep and age at surgery, syndactyly type, or presence of syndromic features.
Reoperation was required in 21 webs (31.8%) with reoperation rates being comparable between LF (34.4%) and FTSG (29.4%) cohorts (
p = 0.793). Most reoperations occurred ?2 years postoperatively, highlighting the importance of long-term follow-up. Median time to reoperation did not differ significantly between cohorts (LF: 4.8 years vs FTSG: 1.9 years,
p = 0.236).
Conclusion:Skin graft-sparing local flaps and full-thickness skin grafts offer comparable outcomes for soft tissue coverage in simple syndactyly release. These results suggest that skin grafts do not reduce reoperation rates and may not be necessary, particularly given the added donor site morbidity. Prospective studies are needed to confirm these findings.
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