Prevention of Web Creep Using a New Frame After Synpolydactyly Surgery

Abstract

The main goal in syndactyly surgery is to create a normal web space; however, it is difficult to achieve the best clinical results in older and complex cases with bony fusions and joint deformities requiring osteotomies. In these complex cases, proper postoperative wound care is difficult to achieve due to the web contractures and deformities. In our report, we introduce a new technique using a frame that we called the "Hittite Sun," which helps in proper wound management to reduce wound healing problems that lead to web creep. Between 2002 and 2006, this frame was used in operations for 46 webs, and the results were compared with those of 30 operated webs in which conventional wound management technique was used. It was found that significantly lower complication rate and lesser web creep formation was seen in these patients, which were managed using the frame, compared with the cases with conventional wound care. The frame was found to be effective for prevention of severe web creep especially in complex synpolydactyly surgery.

Surgical Outcomes and Predictive Factors of Medial Toe Excision for Polysyndactyly of the Fifth Toe

“…As part of such efforts, a new frame was introduced to prevent web creep in complex polysyndactyly of the hand. 9 In regard to the efforts in polysyndactyly of the fifth toe, it is our opinion that our method of a compressive dressing with splinting could immobilize the web space and adjacent toes during the immediate postoperative period and provide optimal healing conditions. In addition, the use of sterile materials with aseptic techniques could reduce the frequency of early postoperative infection.…”

Utilization of a Newly Designed Asymmetric Dorsal Gull Wing Flap for the Treatment of Postoperative Web Creep After Syndactyly Surgery

“…However, in another series, reoperations because of web creep were more frequently performed after using a full-thickness skin graft, but no satisfactory explanation was provided 12 . Some scholars pointed out that wound complications that develop after surgery, instead of the type of the skin graft, were the most important factors for the development of web creep 4 . Another study reported that web creep developed even after reconstruction of the web using flaps, such as using the trilobed flap technique for simple syndactyly, which does not require grafting 13 .…”

“…12 Some scholars pointed out that wound complications that develop after surgery, instead of the type of the skin graft, were the most important factors for the development of web creep. 4 Another study reported that web creep developed even after reconstruction of the web using flaps, such as using the trilobed flap technique for simple syndactyly, which does not require grafting. 13 A study found that once web creep occurred, the original procedure needed to be repeated as the growing bones and joints may become deformed.…”

“…The incidence reported in studies ranges from 7.5% to 60%, and it occurs more frequently when the patient is less than 18 months old at the time of surgery 1–3 . Different surgical methods have been reported to prevent the occurrence of web creep after syndactyly surgery 4,5 ; however, few methods have been reported so far for treating postoperative web creep. In our previous studies, we had performed syndactyly separation with dorsal gull wing flaps 6,7 .…”