Correction of Congenital Syndactyly of the Hand with Minimal Full-Thickness Skin Graft from the Weight-Bearing Midline Plantar Area.

BACKGROUND

Traditional skin grafts for syndactyly often cause color mismatches and unsightly donor sites, whereas no-skin graft methods leave noticeable dorsal hand scars. This study presents a plantar full-thickness skin graft (FTSG) from the weight-bearing midline area for syndactyly repair, a novel approach not previously reported in the literature.

METHODS

The study included 3 groups of patients with congenital syndactyly of the hand who underwent primary operations with plantar FTSG ( n = 70), groin FTSG ( n = 20), and no-skin graft techniques ( n = 22). Postoperative outcomes were evaluated by an assessment panel, and guardians' satisfaction scores were measured. Color similarity between the graft and surrounding skin was assessed using a three-dimensional color space.

RESULTS

The plantar FTSG group demonstrated a significantly higher likelihood of receiving an excellent rating compared with the groin FTSG group, with an odds ratio of 6.30 ( P < 0.001). Color difference analysis showed that plantar FTSG more closely matched surrounding skin color than groin FTSG (6.33 versus 22.57; P < 0.001). Guardians reported greater satisfaction with outcomes on the hand in the plantar FTSG group compared with the groin FTSG and no-skin graft (7.16 versus 5.05 and 4.36; P < 0.001) groups. Satisfaction with donor sites was also significantly higher in the plantar FTSG group than in the groin FTSG group (8.23 versus 6.30; P < 0.001).

CONCLUSION

Correction of congenital hand syndactyly using midline plantar FTSG from the weight-bearing area can reduce scarring on the hand dorsum, ensure superior color similarity with surrounding skin, and offer inconspicuous donor sites compared with no-skin graft or groin FTSG techniques.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.