S A Temtamy, V A McKusick
The genetics of hand malformations.
Birth Defects Orig Artic Ser. 1978;14(3):i-xviii, 1-619.
Abstract/Text
J Zákány, D Duboule
Synpolydactyly in mice with a targeted deficiency in the HoxD complex.
Nature. 1996 Nov 7;384(6604):69-71. doi: 10.1038/384069a0.
Abstract/Text
The morphogenesis of mammalian digits requires the function of several genes of the HoxD complex during development of limb buds. Using embryonic stem (ES) cells and a site-specific recombination system (loxP/Cre), we have induced a deficiency that eliminates the products of the Hoxd-13, Hoxd-12 and Hoxd-11 genes simultaneously. A Hoxd-11/lacz reporter gene replaced the deleted region in order to monitor the effect of this triple inactivation at the cellular level. Mice homozygous for this deficiency showed small digit primordia, a disorganized cartilage pattern and impaired skeletal mass. These alterations are similar to the defects seen in a human synpolydactyly, suggesting that this syndrome, which is associated with a subtle mutation in HOXD13 (ref. 8), may involve the loss of function of several Hoxd genes. These results indicate the existence of a functional hierarchy among these genes and provide us with an animal model to study human digit malformations.
S I Agulnik, V E Papaioannou, L M Silver
Cloning, mapping, and expression analysis of TBX15, a new member of the T-Box gene family.
Genomics. 1998 Jul 1;51(1):68-75. doi: 10.1006/geno.1998.5278.
Abstract/Text
The T-box gene family has been conserved throughout metazoan evolution and codes for putative transcription factors that share a uniquely defining DNA-binding domain. We have previously uncovered six mouse T-box genes with discrete spatial and temporal patterns of expression during embryogenesis. Here, we report a novel mouse T-box gene, Tbx15. The Tbx15 gene produces a 3.7-kb transcript with an open reading frame coding for a polypeptide with 602 amino acid residues. Phylogenetic analysis places the Tbx15 gene into a T-box subfamily that also includes mouse Tbx1, Drosophila H15, and nematode Ce-tbx-12 genes. We have mapped mouse Tbx15 to chromosome 3, at a position 49 cM from the centromere. During development, Tbx15 transcripts are first detected at embryonic day 9.5. The gene is expressed primarily in the cranio-facial region and in the developing limbs. An isolated human homolog, TBX15, has been mapped by in situ hybridization to chromosomal band 1p13. TBX15 appears to be an excellent candidate for the dominantly expressed acromegaloid facial appearance syndrome, which also maps to the short arm of human chromosome 1 and, like TBX15, is expressed prominently in the eyebrow regions.
Copyright 1998 Academic Press.
日本手の外科学会1999年度先天異常委員会：手の先天異常分類法マニュアルの改正について. 日手会誌, 2000; 17: 352-365.
Flatt AE: Classification and incidence. In The Care of Congenital Anomalies, St. Louis, Quality Medical Publishing, 1994;47-63.
A B Swanson
A classification for congenital limb malformations.
J Hand Surg Am. 1976 Jul;1(1):8-22. doi: 10.1016/s0363-5023(76)80021-4.
Abstract/Text
The classification for congenital limb malformations adopted by the American Society for Surgery of the Hand, the International Federation of Societies for Surgery of the Hand, and the International Society of Prosthetics and Orthotics is presented. This method groups similar patterns of deficiencies according to the parts that have been primarily affected by certain embryological failures, whether the insult involves a total part (skeletal and soft tissue) or only the dermomyofascial structures. The main categories of this classification are (I) failure of formation of parts. (II) failure of differentiation (separation) of parts, (III) duplication, (IV) overgrowth, (V) undergrowth, (VI) congenital constriction band syndrome, and (VII) generalized skeletal abnormalities. The rationale and method of use of the classification are discussed. This method has been tested and used in a variety of centers and has been found to be properly conceived and practical.
福本恵三：手先天異常治療の進歩．児島忠雄編．四肢の形成外科最近の進歩 第2版．克誠堂出版， 2005:55-74.
福本恵三, 児島忠雄, 平瀬雄一：合指を呈する先天異常の分類と治療．東日本整災会誌, 2005;17:564-569.
福本恵三, 児島忠雄, 平瀬雄一：裂手症の手術的治療．形成外科, 2008;51:51-59.
J H Dobyns, P R Lipscomb, W P Cooney
Management of thumb duplication.
Clin Orthop Relat Res. 1985 May;(195):26-44.
Abstract/Text
Radial polydactyly, a common congenital problem, most often occurs as thumb duplication. It appears in pentadactylous, polydactylous, and hypoplastic hands and is simulated by complex syndactyly. Classically, there are three categories for radial polydactyly: severe hypoplasia, partial duplication, and total duplication (easily confused with pseudoduplication). The common second category is subcategorized by Wassel's seven types. Management techniques vary with these classifications. Until a decade ago, the standard recommendation was simple excision of one of the duplicates. Problems of deformity, instability, and weakness became apparent, and reconstructive options were developed. Review of a series of 54 duplicate thumbs, all surgically treated, reflects the changing pattern of reconstruction. With current techniques, good results are usual, although secondary reconstructive procedures may be required. Simple excision is seldom indicated. Combination procedures, involving core tissues of bone, joint, and tendon or peripheral tissues--neurovascular, subcutaneous, and skin--or sometimes all of these, are preferred for reconstruction. The major current problem is to achieve the maximal good result with a minimal number of surgical operations.
K Tada, K Yonenobu, Y Tsuyuguchi, H Kawai, T Egawa
Duplication of the thumb. A retrospective review of two hundred and thirty-seven cases.
J Bone Joint Surg Am. 1983 Jun;65(5):584-98.
Abstract/Text
Over a twenty-two-year period, 237 patients (261 hands) with duplication of the thumb were seen in the Hand Clinic of Osaka University Hospital. Two groups were identified: Group A, 141 patients without previous surgical treatment, and Group B, ninety-six patients with residual deformity despite previous surgical treatment. Using a modification of Wassel's classification, seven types of deformity were defined. In Group A these types were identified on the basis of the observed duplications of bone and soft tissue. In all but ten of the Group-B patients preoperative roentgenograms were not available and the type of deformity had to be deduced from the residual duplicated bone, the surgical scar, and the residual deformity. Surgery, performed on 193 hands (125 in Group A and sixty-eight in Group B), attempted to restore normal anatomical relationships. The results could be evaluated in 130 hands according to the range of motion, joint stability, and alignment of the remaining thumb after an average follow-up of 35.0 months. According to the rating system described, the results were rated as good in 75.5 per cent, fair in 20.2 per cent, and poor in 4.3 per cent of the ninety-four hands in Group-A patients who were followed. In the thirty-six hands of Group-B patients who could be followed, the preoperative and postoperative scores were compared. Thirteen were not improved while the other twenty-three, sixteen improved from fair to good and seven improved from poor to fair, to give a good result in 63.9 per cent of the Group-B patients who were followed. The results in these 130 Group-A and B hands emphasize the importance of providing muscle balance and, in young patients, of performing an arthroplasty of the interphalangeal or metacarpophalangeal joint when indicated, although arthrodesis was indicated as a salvage operation for Group-B patients who were more than fifteen years old.
H Kawabata, K Tada, K Masada, H Kawai, K Ono
Revision of residual deformities after operations for duplication of the thumb.
J Bone Joint Surg Am. 1990 Aug;72(7):988-98.
Abstract/Text
We treated thirty-six patients (thirty-eight thumbs) who had residual deformity after ablation of a duplicated thumb. The deformities were classified into three groups: interphalangeal (eight thumbs), metacarpophalangeal (sixteen thumbs), and zigzag (fourteen thumbs). The indication for operation was primarily cosmetic; only eight patients had a functional disability, and that was mild. At the most recent follow-up, the results were rated good except for three fair results in the group that had an interphalangeal deformity, two fair results in the group that had a metacarpophalangeal deformity, and two poor and seven fair results in the group that had a zigzag deformity.
T Ogino, S Ishii, S Takahata, H Kato
Long-term results of surgical treatment of thumb polydactyly.
J Hand Surg Am. 1996 May;21(3):478-86. doi: 10.1016/S0363-5023(96)80366-2.
Abstract/Text
One hundred thirteen hands exhibiting thumb polydactyly were treated and followed up for an average of 49 months. Of these, 109 hands were treated by resection of a supernumerary hypoplastic thumb. Radial thumbs were resected in 107 hands and ulnar thumbs in 2 hands. Four hands were treated using a modified Bilhaut procedure. According to a modified Tada's evaluation, the results were evaluated as good in 97 hands, fair in 12 hands, and poor in 4 hands. Patients and/or their parents were satisfied with the results in 100 hands and dissatisfied with the results in 13 hands. The factors that influenced the surgical results were analyzed. The incidence of unsatisfactory results was relatively high in Wassel types 3, 5, and 6 and triphalangeal-type thumb polydactyly. It was higher when the ulnar digit was removed than when the radial digit was removed. The results for those patients treated between 1983 and 1991 were better than for those treated between 1976 and 1982. The type of deformity, type of procedure, and skillfulness of the surgeon were factors in the results after surgery.
J C Cheng, K M Chan, G F Ma, P C Leung
Polydactyly of the thumb: a surgical plan based on ninety-five cases.
J Hand Surg Am. 1984 Mar;9(2):155-64.
Abstract/Text
Preaxial polydactyly constitutes the most common group of congenital anomalies of the hand among the Chinese population of Hong Kong. Ninety-five cases from the Orthopaedic/Plastic and Reconstructive Surgery Unit, Princess Margaret Hospital, Hong Kong (March 1976 to March 1981), were reviewed. The cases were classified according to Wassel's classification (1969) into seven types. The most common category was type IV followed by types II, V, III, VII, I, and VI. The treatment of each type was analyzed. Bilhaut's procedure was satisfactory for type I, and a modified technique was used for types II and III. A method of shaving the incongruous articular cartilage was used in type IV. Removal of the extra digit and osteotomy of the metacarpal usually were required for type V. The experience with types VI and VII was too limited for assessment. Short-term results (1 to 6 years) have been satisfactory, but follow-up until skeletal maturity to assess the ultimate functional and cosmetic results is necessary.
H D Wassel
The results of surgery for polydactyly of the thumb. A review.
Clin Orthop Relat Res. 1969 May-Jun;64:175-93.
Abstract/Text
T W Marks, L G Bayne
Polydactyly of the thumb: abnormal anatomy and treatment.
J Hand Surg Am. 1978 Mar;3(2):107-16.
Abstract/Text
In nine years 26 duplicated thumbs were seen in the hand clinic of a hospital for crippled children. Using a classification based on the level and degree of duplication and a knowledge of the abnormal anatomy, reconstruction was done. This surgery was done with proper skin incisions, reconstructions of the collateral ligaments, centralization of the flexor and extensor tendons, and alignment of the bones and joints by corrective osteotomies. Simple ablation or incomplete correction produced complications such as skin contractures, increased angular deformities, unstable joints, and intrinsic weakness. In all of the patients, the appearance was improved, opposition was maintained, and postoperative function was not impaired.
C H Yen, W L Chan, H B Leung, K H Mak
Thumb polydactyly: clinical outcome after reconstruction.
J Orthop Surg (Hong Kong). 2006 Dec;14(3):295-302.
Abstract/Text
PURPOSE: To evaluate clinical and cosmetic outcomes of reconstruction in thumb polydactyly and prognostic value of the Wassel classification.
METHODS: Between 1993 and 2000 inclusive, out of the patients with thumb polydactyly (involving 80 thumbs) operated on, 34 patients (36 thumbs) were available for review and underwent clinical and radiological assessment. Outcomes in terms of the Tada score and complications were recorded.
RESULTS: The mean age of patients at the time of operation was 2.8 (range, 0.6-47) years. The mean follow-up period was 5 (range, 2.4-10) years. According to the Wassel classification, 12 were type-II thumb polydactyly, 3 type-III, 11 type-IV, 6 type-V, one type-VI, and 3 type-VII. There was no perioperative mortality or wound infection. More than 88% of the patients were satisfied or very satisfied with functional and cosmetic outcomes. Postoperative complications such as scar hypertrophy, pulp atrophy, joint deformity, and instability were common but minor. Ridge nail deformity after the Bilhaut Cloquet procedure was amenable to secondary corrective procedures. All types of operated thumb polydactyly achieved similar mean Tada scores (14.7- 16.6 out of 20). The Wassel classification category, age, and surgical procedures were found to have no prognostic value with regard to the Tada score and presence of complications.
CONCLUSION: Surgery on thumb polydactyly is rewarding. The Wassel classification category can be used as a guide for treatment, although it fails to predict the occurrence of postoperative complications or Tada scores. Our patients' results can serve as guidelines of expected outcomes after reconstructive procedures in different sub-types of thumb polydactyly.
平山隆三 多田博，勝木雅敏，他:母指多指症の長期術後成績の検討.臨整外,1996;31: 279-80.
C C Lee, H Y Park, J O Yoon, K W Lee
Correction of Wassel type IV thumb duplication with zigzag deformity: results of a new method of flexor pollicis longus tendon relocation.
J Hand Surg Eur Vol. 2013 Mar;38(3):272-80. doi: 10.1177/1753193412460809. Epub 2012 Sep 27.
Abstract/Text
The purpose of this study is to present a treatment algorithm and a method of flexor pollicis longus tendon relocation for Wassel type IV thumb duplication with zigzag deformity. Forty-two thumbs in 42 patients were included in this study and the mean follow-up was 4 years. In addition to excision of the extra digit, tendon relocation and metacarpal and/or proximal phalangeal osteotomy were carried out, based on the degree of angulation at the metacarpophalangeal and interphalangeal joints. Tendon relocation was achieved using our pull-out suture technique. The results were assessed using an evaluation form for thumb polydactyly provided by the Japanese Society for Surgery of the Hand. At the time of latest clinical contact, eight cases were rated good, 31 cases fair, and three cases poor. It is useful to decide surgical procedures according to the degree of angulation of the metacarpophalangeal and interphalangeal joints and flexor pollicis longus tendon relocation is important to prevent malalignment at the interphalangeal joint.
Emiko Horii, Tatsuya Hattori, Syukuki Koh, Masataka Majima
Reconstruction for Wassel type III radial polydactyly with two digits equal in size.
J Hand Surg Am. 2009 Dec;34(10):1802-7. doi: 10.1016/j.jhsa.2009.07.018. Epub 2009 Nov 7.
Abstract/Text
PURPOSE: To report the surgical outcomes for Wassel type III radial polydactyly thumbs of equal or nearly equal size treated by excising the radial thumb with augmentation.
METHODS: We have reconstructed 15 cases of Wassel type III radial polydactyly, in which the duplicated digits were equal or almost equal in size, by ablation of a radial digit. The distal articular surface of the radial proximal phalanx was preserved in order to maintain stability of the interphalangeal joint. The stability of the retained thumb was further augmented by tendon repositioning, restoration of the radial collateral ligament, and transfer of soft tissues from the radial digit. Eleven of 15 cases were followed up for more than 2 years and were available for assessment using the Japanese Society for Surgery of the Hand evaluation form. The average age at follow-up was 8 years and 3 months. The size of the nail and distal phalanx was measured to assess the growth of the thumb.
RESULTS: An average functional point was 12 points (maximum 14 points), and restricted interphalangeal joint motion and extension lag were the disadvantages of this technique. The width of the distal phalanx was increased from 62% of the size of the metacarpal before surgery to 78% at the final follow-up. The cosmetic score averaged 3.6 (maximum 4 points), and slightly small nails without a central ridge were deemed acceptable.
CONCLUSIONS: Our technique can provide a functionally good thumb for Wassel type III radial polydactyly.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
射場浩介:母指多指症の診断と治療.整災外,2008; 51:141-8.
Marios D Vekris, Marios G Lykissas, Panayiotis N Soucacos, Anastasios V Korompilias, Alexandros E Beris
Congenital syndactyly: outcome of surgical treatment in 131 webs.
Tech Hand Up Extrem Surg. 2010 Mar;14(1):2-7. doi: 10.1097/BTH.0b013e3181c660f3.
Abstract/Text
Congenital syndactyly is one of the most common congenital hand differences and various methods of surgical treatment have been described since the 19th century. Nevertheless, unsatisfactory results including web creep, flexion contractures, and rotational deformities of the fingers are still reported. This study presents the outcome of syndactyly release in 131 webs in 78 patients. The sex ratio was 40 males/38 females. The age ranged from 4 months to 22 years (average: 4 y). In the majority of the webs the result was good or excellent. The type of flaps used for the reconstruction of the web was important as the combination of a dorsal rectangular and 2 volar triangular flaps gave superior results than the use of 2 triangular flaps. The less rewarding overall outcome was obtained in the presence of associated differences of the involved fingers, that is, complex complicated syndactyly and in the cases of delayed correction. Use of a dorsal rectangular flap in combination with 2 volar triangular flaps and use of full thickness skin grafts, ensure a satisfactory outcome and minimize the number of operations per web.
沢辺一馬,石川浩三, 鈴木義久,他:皮膚性合指症手術法の検討．日手会誌,2011;27: 498-502.
中村純次,久保英一,栗本砂里奈,他:合指症に対する我々の手術法 日手会誌,1992;9: 139-42.
Junpei Miyamoto, Tomohisa Nagasao, Shimpei Miyamoto
Biomechanical analysis of surgical correction of syndactyly.
Plast Reconstr Surg. 2010 Mar;125(3):963-8. doi: 10.1097/PRS.0b013e3181cb6743.
Abstract/Text
BACKGROUND: The dorsal rectangular flap technique has been widely used for the correction of syndactyly. In this method, however, the linear scar along the palmar border of the webspace may lead to secondary contracture and web creep. Some modifications have been advocated for breaking these linear scars. In this study, these modifications were evaluated biomechanically with the finite element method.
METHODS: Based on computed tomography findings of seven adult hands, three scar models were created: the dorsal rectangular flap, the dorsal flap with palmar-based triangular flap, and the dorsal flap with V-shaped tip. Forced displacements were applied to mimic the hand-opening motion, and scar stresses and web displacement were investigated.
RESULTS: The maximal stress of the scar was significantly greater in the dorsal rectangular flap group than in the other groups (dorsal flap with palmar-based triangular flap, p = 0.046; dorsal flap with V-shaped tip, p = 0.018). The web was displaced most distally in the dorsal rectangular flap group compared with the other groups (dorsal flap with palmar-based triangular flap, p = 0.043; dorsal flap with V-shaped tip, p = 0.043). There was no significant difference between the dorsal flap with a palmar-based triangular flap group and the dorsal flap with a V-shaped tip group.
CONCLUSIONS: The authors' results indicate that both the palmar-based triangular flap and the V-shaped tip flap work well. It is strongly recommended that any break should be made in the palmar edge of the webspace for prevention of web creep.
石川浩三,沢辺一馬,田浦夏希,他:皮膚性合指症に対する我々の治療法の変遷と術後誇刊而．日手会誌,2008;24 : 491-5.
内田満,栗原邦弘 ,篠田明彦,他:植皮片の位置と指のバランスを考慮した合指症手術.日手会誌,2003;20: 193-6,.
Onder Tan, Bekir Atik, Duygu Ergen
Versatile use of the VM-plasty for reconstruction of the web space.
Ann Plast Surg. 2005 Dec;55(6):623-8.
Abstract/Text
The loss of web space may be congenital or acquired. Although local skin flaps are usually preferred, recurrence rate is fairly high. In this study, we used the VM-plasty as a versatile technique to create a web space and expanded its applications. Thirteen patients (7 males and 6 females) with 22 syndactylous webs were operated on using this technique. The web contractures were developed on scarred tissues in 9 patients, whereas only 4 cases presented with primary congenital syndactylies. The skin graft was not used in any of the patients. All the patients gained web functions with a good esthetic appearance without any recurrence. The technique is fairly versatile and can be used both in the hand and foot for congenital complete or incomplete syndactylies and acquired web space contractures. So, we advise the VM-plasty both in primary and recurrent cases with web space loss.
Cengiz Yildirim, Sadk Sentürk, Kenan Keklikçi, Ibrahim Akmaz
Correction of syndactyly using a dorsal separated V-Y advancement flap and a volar triangular flap in adults.
Ann Plast Surg. 2011 Oct;67(4):357-63. doi: 10.1097/SAP.0b013e3181fc055a.
Abstract/Text
Skin grafts and local flaps are conventional methods of repair for congenital syndactyly, but the results obtained are not always as functional and aesthetic as desired and frequently leave postoperative scars and residual syndactyly. In this article, we describe a new surgical technique for web reconstruction in the correction of simple, incomplete syndactyly. The technique consists of a dorsal separated V-Y advancement flap and a volar triangular flap to cover the newly created web space, thus avoiding skin graft in this space. In all, 15 web spaces in 10 patients were treated using this method. A follow-up period of 6 months to 2 years showed neither recurrence of the deformity nor web creep of any degree. The technique is rapid, safe, easily performed, and reproducible and requires a single surgical procedure. It uses donor tissue identical in color, texture, and thickness, which renders acceptable cosmesis in cases of simple, incomplete syndactyly, therefore, avoiding the use of skin grafts and resulting postoperative scar contracture in the web space.
久保田夏枝,浜島昭人,村松英之,他:先天性皮膚性合指症に対する皮下茎皮弁による指問形成の経験.形成外科,2011;54: 1163-8.
N S Niranjan, S M Azad, A N M Fleming, S H Liew
Long-term results of primary syndactyly correction by the trilobed flap technique.
Br J Plast Surg. 2005 Jan;58(1):14-21. doi: 10.1016/j.bjps.2004.05.031.
Abstract/Text
This paper describes the long term results of a surgical technique used for correction of syndactyly. This technique has been practised by the senior author since 1987 and was published in 1990. The technique involves the use of a dorsal trilobed flap for the reconstruction of the commissure and zig-zag incisions for the fingers. This technique does not require the use of skin grafts. This technique has been used in 62 webs in 44 patients. In this total group, there were 30 patients of primary hand syndactyly with 40 webs. Seventeen patients of primary syndactyly with 25 webs were followed up. The follow-up of these patients ranged from 2 years to 12 years. The long term results reveal a simple, effective technique which does not require the use of skin grafts, and is associated with good functional and far superior cosmetic results.
Hajime Matsumine, Yuichiro Yoshinaga, Osamu Fujiwara, Ryo Sasaki, Masaki Takeuchi, Hiroyuki Sakurai
Improved "bell-bottom" flap surgical technique for syndactyly without skin graft.
Plast Reconstr Surg. 2011 Nov;128(5):504e-509e. doi: 10.1097/PRS.0b013e31822b696d.
Abstract/Text
BACKGROUND: This study describes the use of a modified "bell-bottom" flap for treatment of partial syndactyly release that may avoid the use of skin grafting.
METHODS: A retrospective review of this procedure was performed for 12 interdigital space reconstructions. Patients were aged 1 to 5 years 6 months. The mean follow-up period was 24 months. The operations were performed to avoid skin grafting. The flap was designed in the narrow-spaced and fused interdigital region of syndactyly for preventing postoperative scar contracture and web formation.
RESULTS: Surgery was completed without skin grafting in all cases. The use of a modified flap allowed the construction of interdigital spaces with sufficient width, providing satisfactory cosmetic outcomes. No partial necrosis or complications were observed. No web formation, elevation of the interdigital space, or limited range of joint motion caused by contracture was observed during the 2-year follow-up period, and no secondary correction was needed.
CONCLUSION: The present surgical technique may be a new surgical option for web release in which fingers are fused at a level lower than the midpoint between the proximal and distal interphalangeal joints.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
坂東行洋,梁井岐,瀬野久和,他:先天性及び熱傷性軽度合指に対するthree-square-flap法による指間 形成術.形成外科,1996;39: 131-6.
Vivian M Hsu, James M Smartt, Benjamin Chang
The modified V-Y dorsal metacarpal flap for repair of syndactyly without skin graft.
Plast Reconstr Surg. 2010 Jan;125(1):225-32. doi: 10.1097/PRS.0b013e3181c49686.
Abstract/Text
BACKGROUND: Syndactyly repairs that use full-thickness skin grafts risk graft-related complications. The dorsal V-Y advancement flap offers a method of syndactyly release that can eliminate the need for full-thickness skin grafts in some cases of simple syndactyly.
METHODS: A retrospective case series of all patients undergoing syndactyly release without skin grafting performed by the senior author (B.C.) between 1998 and 2007 was conducted. All outpatient and inpatient charts were reviewed for pertinent patient demographics and clinical outcomes, including the incidence of web creep, hypertrophic scarring, flexion contracture, infection, angulation deformity, limited range of motion, ischemia, and need for reoperation.
RESULTS: A total of 28 syndactylies were included in the study: 25 simple incomplete and three simple complete. Mean follow-up time was 4.2 years. Mean operative time was 68 minutes. Two patients (7.1 percent) experienced postoperative complications; both were corrected by subsequent revision.
CONCLUSION: The dorsal V-Y advancement flap without skin graft is an effective method of repair primarily in simple incomplete syndactyly.
石田知良,関口順斬,小林誠一郎,他:われわれの行っている指間水かきに対する手術法.形成外科,1988;31: 336-44.
石川浩三,沢辺一馬,田浦夏希,他:皮膚性合指症に 対する我々の治療法の変造と術後評価．日手会誌,2008;24: 491-5.
沢辺一馬,石川浩三,鈴木義久,他:皮膚性合指症手術法の検討．日手会誌, 2001;27: 498-502.
袖井文二,奈良卓,湊祐肱 他:手指先天異常の長期経過観察．日手会誌,1996;12: 787-91.
林博之,愛国康男,小林正大,他:手指への腔骨内果下部からの全層植皮術．日手会誌,2000;16: 694-7.
