{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T21:55:10Z","timestamp":1776462910647,"version":"3.51.2"},"reference-count":18,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Foot\u2010syndactyly has long been managed through conventional surgical procedures, each having its own distinct advantages and drawbacks. While these methods, which do not require skin grafts, exhibit a lower incidence of long\u2010term complications, they lead to undesirable scarring on the dorsal side of the foot and reduced patient satisfaction. In this study, we introduce an innovative technique involving an intermetatarsal plantar flap, supported by an anatomical investigation and clinical application.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eight freshly preserved lower limbs were injected with colored latex to examine the cutaneous vessels on the plantar surface, a skin\u2010flap was designed in an elliptical shape to address first web conjoined toes. The flap was extended from the center of each affected ray measuring ~30% of the sole's length. Using the mentioned novel approach, a flap was created and dorsally extended with a straight incision to release bilateral simple foot\u2010syndactyly in an 8\u2010year\u2010old child presented with Apert's Syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified cutaneous branches originating either from the medial plantar vessels or the lateral proper artery of the hallux. On average, the mean number of cutaneous branches found over the first intermetatarsal web spaces was 5.8 (ranging from 5 to 8) most of them originating from medial plantar vessels with a mean of 5.1 branches (range 4\u20136) while proper lateral great\u2010toe digital artery provided a mean of 0.6 branches (range 0\u20132). Intra\u2010operatively, in our patient, advancing the plantar flap ensured complete coverage of the commissure, obviating the necessity for skin grafts. Incisions healed uneventfully and a wide first web was obtained. Over a 15\u2009months follow\u2010up, no complications were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest that the skin\u2010graftless first web release of syndactyly using a plantar intermetatarsal flap is a reliable and straightforward procedure with good cosmetic results, offering a promising alternative to conventional techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Therapeutic IV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31151","type":"journal-article","created":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T13:35:50Z","timestamp":1708090550000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Plantar intermetatarsal perforator flap for first web skin\u2010graftless syndactyly release: Anatomical study and clinical application"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-9868","authenticated-orcid":false,"given":"Francisco","family":"Soldado","sequence":"first","affiliation":[{"name":"Pediatric Hand Surgery and Microsurgery Unit, Barcelona University Children's Hospital HM Nens HM Hospitales  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5488-5981","authenticated-orcid":false,"given":"Jose Antonio","family":"Prieto\u2010Mere","sequence":"additional","affiliation":[{"name":"Institut de la M\u00e0, Hospital Universitario General de Catalunya  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelmounim","family":"Cherqaoui","sequence":"additional","affiliation":[{"name":"Service d'orthop\u00e9die P\u00e9diatrique, H\u00f4pital d'Enfants A. Harouchi Universit\u00e9 de M\u00e9decine Hassan 2  Casablanca Morocco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Diaz Gallardo","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics Department Sant Pau Hospital  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Knorr","sequence":"additional","affiliation":[{"name":"Pediatric Hand Surgery and Microsurgery Unit, Barcelona University Children's Hospital HM Nens HM Hospitales  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Corona","sequence":"additional","affiliation":[{"name":"Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital Universitat Autonoma de Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"865","article-title":"Syndactyly\u2014Current surgical techniques","volume":"11","author":"Baldwin E.","year":"2017","journal-title":"The Open Orthopaedics Journal"},{"issue":"18","key":"e_1_2_6_3_1","first-page":"460","article-title":"Syndactylism: Results of zig\u2010zag incision to prevent postoperative contracture","volume":"1956","author":"Cronin T. D.","year":"1946","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000147664"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/02844310802556968"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(95)90069-1"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2016.43.6.559"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199806000-00013"},{"key":"e_1_2_6_9_1","first-page":"1217","volume-title":"Green's operative hand surgery","author":"McCombe D.","year":"2021"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198302000-00012"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2015.06.008"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2004.05.031"},{"issue":"2","key":"e_1_2_6_13_1","first-page":"204","article-title":"Aesthetic outcome of web space Z\u2010plasty for foot syndactyly","volume":"16","author":"Say R. W.","year":"2021","journal-title":"Hand (N Y)"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31003"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2017.01.021"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(79)80009-X"},{"key":"e_1_2_6_17_1","volume-title":"Pediatric hand surgery","author":"Tonkin M. A.","year":"2012"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2020.01620"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047-023-00660-w"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.31151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T10:26:10Z","timestamp":1747045570000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.31151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1002\/micr.31151"],"URL":"https:\/\/doi.org\/10.1002\/micr.31151","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2]]},"assertion":[{"value":"2023-10-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e31151"}}