Web Creep Reoperation Following Simple Syndactyly Release Using Full-Thickness Skin Grafts and Skin Graft-Sparing Local Flaps.

Abstract

Web creep following syndactyly release is a well-documented problem, yet studies focusing on simple syndactyly are limited. While numerous approaches, including local flaps and skin grafts, have been proposed for skin coverage, existing research lacks sufficient power or follow-up duration to accurately assess web creep rates. This study aimed to compare web creep outcomes between skin graft-sparing local flaps and full-thickness skin grafts after simple syndactyly release. This is a single-institution, retrospective review encompassing patients identified using CPT codes 26560 and 26561 from 2006 to 2024. Inclusion criteria were patients with simple syndactyly with at least 2 years of follow-up and younger than 18 years of age at initial surgery. We collected patient demographics, age at surgery, reoperation timing, web space location, and length of follow-up from the medical record. A total of 42 patients contributing to 66 web commissures (n=32 skin-graft sparing, n=34 full-thickness skin graft) were included in our analysis with an average follow-up length of 7.20±3.77 years. There were no significant differences in age at initial surgery, sex, race, hand, location of web spaces, or length of follow-up between groups. There was a significant difference in complete versus incomplete syndactyly, with 7/34 (20.6%) incomplete webs in the skin-graft group versus 27/34 (79.4%) with complete (P=0.02). Reoperation rates for web creep between the skin graft-sparing local flaps versus full-thickness skin grafts were found to be 34.4% (11/32) and 29.4% (10/34), respectively, having no significant difference (P=0.793), with an average of 31.8% reoperation across both groups. Our findings revealed no difference in reoperation rates between skin graft-sparing local flaps and full-thickness grafts, suggesting that both treatments effectively cover simple syndactyly release without added web creep risk. This may guide decisions on the necessity of the additional morbidity associated with skin graft harvesting. Level III, retrospective cohort study.