Aesthetic Comparison of Two Different Types of Webspace Reconstruction for Finger Syndactyly

Background: Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. Our study compares the long-term aesthetic outcomes of these two flap techniques. Methods: Forty-five patients were included in our study. The methods of reconstruction used were a dorsally-based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting. Eighteen independent raters completed a Visual Analogue Scale (VAS) as well as a unique classification scale to subjectively assess aesthetic outcomes. We used univariate analyses to determine which variables significantly influenced the outcome score. We then used multivariable regression models to compare the two flap types. Results: Dorsally-based rectangular flaps with skin graft had statistically significantly better VAS scores and greater odds of receiving an 'Excellent' rating when compared to dorsal pentagonal advancement flaps. Conclusions: Despite the use of skin graft and their associated donor-site morbidity, dorsal rectangular flaps may offer better overall aesthetic outcomes for patients. Future comparative studies should incorporate functional and patient-reported outcomes to better assess the optimal reconstruction type. Financial Disclosure Statement: This publication was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (2 K24-AR053120-06). The consent is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Corresponding Author: Kevin C. Chung MD, MS, Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5340, Kecchung@med.umich.edu, Phone 734-936-5885, Fax 734-763-5354 ©2018American Society of Plastic Surgeons