A four-pulp flap technique for creating nail folds in the separation of a mid-digital mass in a patient with Apert's disease.

Apert's disease is distinguished from other acrocephalosyndactylys by bilateral and symmetrical deformities, including symphalangism of the hands, which is commonly present in the index, long, and ring fingers. In the correction of the Apert hand, simple separation and skin grafting may be used to create a five-digit hand. However, this technique may result in narrow, atrophic fingertips, and pulp pads. In this paper, a simple technique to create nail folds and pulps for each finger with four transposition flaps from the common pulp is described. During the past 3 years, four Apert hand deformities in 2 patients were treated with this procedure. At a mean follow-up of 32 months, good results were obtained.