Islanded perforator-based flap versus dorsal rectangular flap for syndactyly release: a prospective analytical study

Syndactyly, a congenital hand deformity caused by failed phalangeal separation, often requires surgical correction to restore function and aesthetics. Traditional dorsal rectangular flap techniques involve skin grafting, increasing the risk of web creep and residual deformity. This study evaluates islanded perforator-based flaps, which offer better vascularization for improved outcomes. Preoperative Doppler ultrasound was used for vascular mapping to enhance surgical precision. This prospective observational study analyzed 31 webspaces in 26 patients undergoing syndactyly release. Doppler ultrasound was performed in 15 cases to guide flap selection. Islanded flaps were used when viable, while dorsal rectangular flaps were used otherwise. Data collection included demographics, preoperative evaluation, intraoperative details, and postoperative outcomes. Functional and aesthetic results were assessed using the Withey score, Visual Analog Scale (VAS) from the Patient Observer Scar Assessment Score Scale, and photographic analysis over follow-up. Syndactyly release was performed in 31 webspaces. Doppler mapping optimized flap design. Statistically significant findings showed improved VAS scores postsurgery, especially in younger patients (1-5 years, P = 0.0001 and 6-10 years, P = 0.0065) and males (P = 0.0000). Simple syndactyly had better outcomes than complex cases (P = 0.0004). Long-term VAS scores favored islanded flaps (1.9 ± 0.83) over dorsal flaps (2.60 ± 0.84). Scar quality improved significantly (P < 0.001 for 6+ months), with minimal complications in patients with islanded perforator flaps. Islanded perforator-based flaps present a promising alternative for syndactyly release, delivering superior functional and aesthetic results. The incorporation of Doppler mapping ensures vascular safety and reduces complications. Further research is needed to establish long-term outcomes.