Dorsal Pentagonal Local Flap: A New Technique of Web Reconstruction for Syndactyly Without Skin Graft

Many techniques for web space reconstruction have been described over the years. However, few techniques are completely satisfactory in terms of cosmetic requirement and functional recovery due to scar contracture, web creep, or conspicuous scarring resulting from skin grafting or additional incisions on the dorsal palm. Based on the anatomy of the dorsal metacarpal artery, the authors describe a local pentagonal advancement flap including perforators of the dorsal metacarpal artery to optimize web reconstruction and facilitate direct closure in the syndactyly treatment. A local dorsal pentagonal advancement flap was used to reconstruct 17 web spaces in ten patients. The skin of the syndactylized fingers was brought to the web space from the dorsum of the two adjacent syndactylized fingers to cover the web area, facilitating a skin graft-free procedure for web reconstruction. All 17 web releases were successfully reconstructed. During the follow-up period of 23-35 months, the appearance of all the reconstructed webs was similar to that of the adjacent normal webs, and all the patients had full functional recovery. No case of web creep was reported during this period, and none of the patients required a secondary operation. The dorsal pentagonal advancement flap is a dependable flap based on known perforators from the dorsal metacarpal arteries. The reported technique is a simple and effective technique for the correction of simple syndactyly and is especially suitable for reconstruction of two webs in multiple syndactyly simultaneously, avoiding the need for skin grafts and leaving acceptable scars on the dorsum of the hand for web reconstruction.