Progress in surgical strategies for treatment of simple congenital syndactyly: A systematic review

Abstract

Background

Plenty of surgical strategies for treatment of simple syndactyly have been reported in the past decades. We are most interested in what progresses have been made over the recent 10 years. Our aim was to make a summary of the modified techniques that have been described in the last decade.

Methods

We reviewed English articles from PubMed and Chinese articles from CKNI and CQVIP published between January 2007 and December 2016. We limited the inclusion criteria to simple syndactyly and excluded complex, complicated, and syndrome-associated syndactylies.

Results

We identified 1650 articles and selected 94 for inclusion. Almost half of the included papers proposed modified flaps for web reconstruction. In most cases, a zigzag incision and Buck-Gramcko flaps were still the first choice to separate the fused digits and create the nail folds. Several new donor sites were recommended for skin grafts and several substitute biomaterials were introduced to replace skin grafts. External fixator devices were applied in a wider range for desyndactylization. However, it was not considered to be superior to other graft-less strategies. Postoperative complications were discussed in most papers, but an effective strategy to eradicate these is lacking.

Conclusions

With the development of biomaterials and surgeon's experiences, more and more modified techniques have been conceived. However, no specific technique can be announced to be superior to others. Furthermore, more sensitive outcome measures should be established, and relationship between operative procedures and postoperative complications should be further defined.

Level of evidence: not ratable.