The Double Volar Flap Technique for Aesthetic Repair of Syndactyly and Polysyndactyly of Toe without Skin Grafting

BACKGROUND: Aesthetic repair of syndactyly of the toes is desirable because patients may have psychological concerns about its appearance. There are 2 important factors for the aesthetic repair of syndactyly of the toe. One is to hide the operative scar from the visual site (dorsal site), whereas the other is to create an interdigital space close to the normal anatomical skin characteristics (2 general types of skin: glabrous and hairy). METHODS: In total, 12 patients (4 males and 8 females) with 15 syndactylous webs were operated on by using the double volar flap technique. The following 3 local flaps were designed with this technique: an M-shaped flap designed on the dorsal side of the interdigital region (flap A) and double volar flaps (flaps B and C) designed on the volar side of the interdigital region. Flap A was used for reconstruction of the web slope, whereas flaps B and C were used for reconstruction of the proximal sidewall of toes. RESULTS: The corrected toes showed a deep and natural interdigital commissure with no exposure of skin grafts or conspicuous scars on the dorsal visible side. The scars on the volar side were also inconspicuous. CONCLUSIONS: The double volar flap method for repair of syndactyly and polysyndactyly of the toes has the same advantages as those of the local flap method, in addition to an optimum aesthetic result through matching with the normal anatomical skin characteristic of the interdigital space and hiding of the operative scar from the visual site.