Abstract
Dear Sir,
Re: Syndactyly
The article by Deunk and colleagues (Deunk et al., 2003) adds further evidence to the continuing debate in relation to the use of skin grafts as part of the surgical management of syndactyly correction. However, they unfortunately do not comment on the relationship of the web reconstruction technique to the incidence of web creep. The aetiology of this complication may be more to do with the junctional scars around the base of the digits palmar to the mid-lateral line than to the use of an open technique (no skin grafts) or the type of skin grafts.
This was discussed by Habernicht (2001) who suggested that the transverse palmar incision contributed to the scar contracture. A technique to avoid this complication has been described (Moss and Foucher, 1990). This web reconstruction uses two lateral palmar triangular flaps which sit on either side of a waisted dorsal flap. However, each surgeon used a different type of skin graft (split skin from buttock versus full thickness skin). The outcome in the two groups showed no difference in the incidence of web creep, flexion contracture or reoperation rate. This was true of cases where the grafts failed partially or completely, or where there was evidence of wound infection.
As a small point, I would question the use of percentages, especially when shown in table form, when the numbers in the series are small.