Aesthetic Repair for Syndactyly of the Toes Using a Plantar Rectangular Flap

BACKGROUND: Use of a dorsal rectangular flap is the most common method of creating a deep interdigital space for syndactyly of the toes. However, the pigmented skin grafts exposed to the dorsal side are conspicuous. To resolve this problem, several methods have been reported. However, the local flap methods could be adapted only in mild syndactylies, and plantar skin flaps exposed to the dorsal side are too whitish. Meanwhile, in the methods using skin grafts from the inframalleolar region, the marginal scars of the skin grafts are still conspicuous on the dorsal side. To resolve these problems, the authors devised a new surgical method using a plantar rectangular flap. METHODS: In this method, the authors designed a rectangular flap on the plantar side. Only a small triangular flap and a slight zigzag skin-incision line were designed on the dorsal side. The plantar rectangular flap was put down into the bottom of the interdigital space and was sutured with the dorsal triangular flap. Full-thickness skin was grafted to the raw surface at the sides of the divided toes. RESULTS: The authors performed this method on 18 syndactylies of 12 patients. In all cases, the corrected toes showed a deep and natural interdigital space without exposure of skin grafts or conspicuous scars. CONCLUSIONS: The authors devised the plantar rectangular flap to avoid extra skin defects on the dorsal side. Using this method, the authors can create a deep interdigital space without any exposure of skin grafts or whitish plantar skin flaps on the dorsal side. This method is not appropriate for syndactyly of the fingers but is an ideal method for syndactyly of the toes.