Application of dorsal foot hexagonal flap for reconstruction of web space in fourth and fifth toe syndactyly combined with polydactyly_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHANG Hao , ZHANG Fang , LUO Pengyuan , REN Qiang , WANG Kang

The 1st Department of Orthopedics, Hebei Province Children’s Hospital, Shijiazhuang Hebei, 050031, P.R.China;

Corresponding author：

SHANG Hao, Email: 15832136592@163.com

Keywords：

Polydactyly; syndactyly; little toe; hexagonal flap; toe web

DOI：

10.7507/1002-1892.202007076

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the application of the dorsal foot hexagonal flap for reconstruction of the web space in the fourth and fifth toe syndactyly combined with polydactyly.Methods Between May 2016 and October 2019, 27 patients (34 feet) with the fourth and fifth toe syndactyly combined with polydactyly were treated, including 12 males and 15 females with an average age of 22.8 months (range, 10 months to 8 years). There were 7 bilateral feet and 20 unilateral foot. Twenty-four of which were incomplete and 10 were complete syndactyly of the fourth and fifth toes, and the fifth toes showed various degrees of fibular deflection. All the 34 feet were treated with one-stage reconstruction of the toe web with the dorsal foot hexagonal flap, and the correction of the fibular deviation of the fifth toe was made by removing the tibial polydactyly and using the articular surface dressing or wedge osteotomy.Results All wounds healed by first intention without skin-frafting. All patients were followed up 6-36 months (mean, 18 months). There was no flexion contracture and obvious scar hyperplasia in all the patients, and the width and slope of the toe webs were normal. Three of the 34 webs developed web creep, and the rest of the toe webs were normal in depth. All 34 feet were corrected with peroneal fibular deviation, and the function of toe flexion was good. All parents of the children were satisfied with the outcome.Conclusion The reconstruction of toe webs with dorsal foot hexagonal flaps for the treatment of the fourth and fifth toes syndactyly combined with polydactyly requires no skin graft. The operation is simple with high survival rate of the flap, the appearance and function of the toes are good, and the effectiveness is satisfactory.

Citation： SHANG Hao, ZHANG Fang, LUO Pengyuan, REN Qiang, WANG Kang. Application of dorsal foot hexagonal flap for reconstruction of web space in fourth and fifth toe syndactyly combined with polydactyly. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1590-1593. doi: 10.7507/1002-1892.202007076 Copy

1.	Watanabe H, Fujita S, Oka I. Polydactyly of the foot: An analysisof 265 cases and a morphological classifification. Plast Reconstr Surg, 1992, 89: 856-876.
2.	Lee HS, Park SS, Yoon JO, et al. Classification of postaxial polydactyly of the foot. Foot Ankle Int, 2006, 27(5): 356-362.
3.	Son D, Kim H, Kim J, et al. Anatomic correction of polysyndactyly of the fifth toe fused with the fourth toe. Br J Plast Surg, 2005, 58(6): 873-876.
4.	Iida N, Kotake A. A new surgical procedure for little toe polysyndactyly without skin graft. Ann Plast Surg, 2011, 67(2): 167-169.
5.	Phelps DA, Grogan DP. Polydactyly of the foot. J Pediatr Orthop, 1985, 5(4): 446-451.
6.	Nakamura K, Ohara K, Ohta E. A new surgical technique for postaxial polydactyly of the foot. Plast Reconstr Surg, 1996, 97(1): 133-138.
7.	Yamada N, Takayama A, Takeda A, et al. An ideal surgical technique for postaxial polysyndactyly of the toes. J Plast Reconstr Aesthet Surg, 2012, 65(12): e357-358.
8.	Christensen JC, Leff FB, Lepow GM, et al. Congenital polydactyly and polymetatarsalia: classification, genetics, and surgical correction. J Foot Surg, 1981, 20(3): 151-158.
9.	Oragui E, Eli N, Folaranmi S, et al. An unusual case of fibular (postaxial) polydactyly: extrametatarsal head with fused duplication of the proximal phalanx. J Foot Ankle Surg, 2012, 51(4): 468-471.
10.	Morley SE, Smith PJ. Polydactyly of the feet in children: suggestions for surgical management. Br J Plast Surg, 2001, 54(1): 34-38.
11.	Lui TH. Correction of postaxial metatarsal polydactyly of the foot by percutaneous ray amputation and osteotomy. J Foot Ankle Surg, 2013, 52(1): 128-131.
12.	Iba K, Ozasa Y, Hanaka M, et al. Midterm and long-term follow-up after surgical reconstruction for lateral polydactyly of the foot with mosaic-like alignment of the phalanx bones. J Pediatr Orthop, 2020, 40(1): e30-e36.
13.	Hayashi A, Yanai A, Komuro Y, et al. A new surgical technique for polysyndactyly of the toes without skin graft. Plast Reconstr Surg, 2004, 114(2): 433-438.
14.	Lim YJ, Teoh LC, Lee EH. Reconstruction of syndactyly and polysyndactyly of the toes with a dorsal pentagonal island flap: a technique that allows primary skin closure without the use of skin grafting. J Foot Ankle Surg, 2007, 46(2): 86-92.
15.	Miyanaga T, Shimada K, Kishibe M, et al. The double volar flap technique for aesthetic repair of syndactyly and polysyndactyly of toe without skin grafting. PRS Global Open, 2017, 5(4): e1293.
16.	Gao W, Yan H, Zhang F, et al. Dorsal pentagonal local flap: a new technique of web reconstruction for syndactyly without skin graft. Aesthetic Plast Surg, 2011, 35(4): 530-537.

1. Watanabe H, Fujita S, Oka I. Polydactyly of the foot: An analysisof 265 cases and a morphological classifification. Plast Reconstr Surg, 1992, 89: 856-876.
2. Lee HS, Park SS, Yoon JO, et al. Classification of postaxial polydactyly of the foot. Foot Ankle Int, 2006, 27(5): 356-362.
3. Son D, Kim H, Kim J, et al. Anatomic correction of polysyndactyly of the fifth toe fused with the fourth toe. Br J Plast Surg, 2005, 58(6): 873-876.
4. Iida N, Kotake A. A new surgical procedure for little toe polysyndactyly without skin graft. Ann Plast Surg, 2011, 67(2): 167-169.
5. Phelps DA, Grogan DP. Polydactyly of the foot. J Pediatr Orthop, 1985, 5(4): 446-451.
6. Nakamura K, Ohara K, Ohta E. A new surgical technique for postaxial polydactyly of the foot. Plast Reconstr Surg, 1996, 97(1): 133-138.
7. Yamada N, Takayama A, Takeda A, et al. An ideal surgical technique for postaxial polysyndactyly of the toes. J Plast Reconstr Aesthet Surg, 2012, 65(12): e357-358.
8. Christensen JC, Leff FB, Lepow GM, et al. Congenital polydactyly and polymetatarsalia: classification, genetics, and surgical correction. J Foot Surg, 1981, 20(3): 151-158.
9. Oragui E, Eli N, Folaranmi S, et al. An unusual case of fibular (postaxial) polydactyly: extrametatarsal head with fused duplication of the proximal phalanx. J Foot Ankle Surg, 2012, 51(4): 468-471.
10. Morley SE, Smith PJ. Polydactyly of the feet in children: suggestions for surgical management. Br J Plast Surg, 2001, 54(1): 34-38.
11. Lui TH. Correction of postaxial metatarsal polydactyly of the foot by percutaneous ray amputation and osteotomy. J Foot Ankle Surg, 2013, 52(1): 128-131.
12. Iba K, Ozasa Y, Hanaka M, et al. Midterm and long-term follow-up after surgical reconstruction for lateral polydactyly of the foot with mosaic-like alignment of the phalanx bones. J Pediatr Orthop, 2020, 40(1): e30-e36.
13. Hayashi A, Yanai A, Komuro Y, et al. A new surgical technique for polysyndactyly of the toes without skin graft. Plast Reconstr Surg, 2004, 114(2): 433-438.
14. Lim YJ, Teoh LC, Lee EH. Reconstruction of syndactyly and polysyndactyly of the toes with a dorsal pentagonal island flap: a technique that allows primary skin closure without the use of skin grafting. J Foot Ankle Surg, 2007, 46(2): 86-92.
15. Miyanaga T, Shimada K, Kishibe M, et al. The double volar flap technique for aesthetic repair of syndactyly and polysyndactyly of toe without skin grafting. PRS Global Open, 2017, 5(4): e1293.
16. Gao W, Yan H, Zhang F, et al. Dorsal pentagonal local flap: a new technique of web reconstruction for syndactyly without skin graft. Aesthetic Plast Surg, 2011, 35(4): 530-537.

Chinese Journal of Reparative and Reconstructive Surgery

Application of dorsal foot hexagonal flap for reconstruction of web space in fourth and fifth toe syndactyly combined with polydactyly

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