{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T09:01:57Z","timestamp":1792918917536,"version":"4.5.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Simple syndactyly is a common congenital upper extremity difference. Traditional reconstructive approaches use skin grafts; however, recent studies suggest that skin graftless techniques may improve outcomes. The authors hypothesized that patients who underwent reconstruction with a skin graftless dorsal metacarpal island VY advancement flap would have fewer postoperative complications compared with those released with a dorsal rectangular flap with skin grafts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Patients aged 0 to 17 years presenting for primary reconstruction of simple syndactyly were analyzed retrospectively at a large pediatric hospital. Medical records were identified using\n                      <jats:italic toggle=\"yes\">International Classification of Diseases, Ninth Revision<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">Tenth Revision<\/jats:italic>\n                      codes, CPT codes, and case logs from 6 hand surgeons. Outcomes of interest included early postoperative complications (within 30 days) such as infection, hematoma, seroma, wound healing issues, unplanned returns to the operating room, and digit loss. Late complications (&gt;30 days) included web creep and development of pathologic scar formation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 213 syndactyly repairs from 153 patients were analyzed (rectangular, 94 webspaces and 58 patients; VY, 119 webspaces and 95 patients). The rectangular group had significantly more early complications (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04). The rectangular group had significantly higher incidences of web creep and hypertrophic scarring (19.3% versus 1.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001; 19.1% versus 5.9%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.003, respectively). The rectangular flap with skin grafts was the only variable predictive of web creep and hypertrophic scar formation on regression analysis (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.004, respectively). Subgroup analyses of syndromic and nonsyndromic cases and incomplete and complete cases mirrored overall cohort results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Simple syndactyly releases with the skin graftless technique produces fewer complications compared with the traditional approach with skin grafts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL QUESTION\/LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Therapeutic, III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/prs.0000000000011925","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T12:00:10Z","timestamp":1734436810000},"page":"969-981","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Skin Graftless Dorsal Metacarpal Island VY Advancement Flap versus Dorsal Rectangular Flap with Skin Grafting in 213 Simple Syndactyly Releases"],"prefix":"10.1097","volume":"155","author":[{"given":"Shaun D.","family":"Mendenhall","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Spencer Fox Eccles School of Medicine at the University of Utah and Intermountain Primary Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Graham","sequence":"additional","affiliation":[{"name":"Section of Plastic Surgery, Department of Surgery, University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe E.","family":"Belardo","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza","family":"Buttrick","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B.","family":"Card","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children\u2019s Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apurva S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery"},{"name":"Perelman School of Medicine at the University of Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery"},{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children\u2019s Hospital of Philadelphia"},{"name":"Perelman School of Medicine at the University of Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,12,17]]},"reference":[{"key":"R1-20250730","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1002\/ajmg.1320050406","article-title":"Syndactyly: frequency of specific types.","volume":"5","author":"Castilla","year":"1980","journal-title":"Am J Med Genet"},{"key":"R2-20250730","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2174\/1874325001206010014","article-title":"The epidemiology, genetics and future management of syndactyly.","volume":"6","author":"Jordan","year":"2012","journal-title":"Open Orthop J"},{"key":"R3-20250730","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/S0363-5023(82)80101-9","article-title":"An estimate of the population 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