Correction of postburn syndactyly: an analysis of children with introduction of the VM-plasty and postoperative pressure inserts.

An analysis of 190 operations for correction of postburn syndactyly in children showed that none of the procedures commonly used was entirely satisfactory because of partial recurrence of the lesion or less than optimal cosmetic results. Complete correction of the dorsal slant was a particular problem. Because of this, a new operation, designated the VM-plasty, was devised specifically for correction of postburn syndactyly, and this procedure was evaluated in 24 deformities. Our experience suggests that incision of the web with simple closure, simple YV-plasties, and simple or complex Z-plasties should not be used for postburn correction of webs 2, 3, and 4. The five-flap technique of Rousso and, occasionally, Z-plasties are suitable for correction of simple webs of the thumb space, and rotational flaps are suitable in some instances for correction of webs 2, 3 and 4. However, the VM-plasty now appears to be preferable in all instances of volar or dorsal webs where there is no limitation of the back of the hand at or distal to the metacarpophalangeal joints with the fist clenched. Contractures limiting the clenched fist usually require a graft to achieve complete anatomic correction. An adjunctive procedure of graded interdigital pressure inserts was evaluated following the correction of 28 webs and appeared to prevent the appearance of hypertrophic scar formation with improved cosmetic appearance and preservation of the dorsal slant.