Surgical Approaches and Outcomes for 69 First Web Space Congenital Syndactyly Cases of the Hand.

Purpose: First web space syndactyly presents a considerable reconstructive challenge, and because of the rarity and complexity of the condition, there is no consensus on the optimal approach to its reconstruction. This study therefore describes our experience with congenital first web space syndactyly, providing an overview of reconstructive techniques and outcomes. Methods: Sixty-nine cases (55 simple and 14 complex/complicated), from 2007 to 2022, were analyzed with descriptive statistics. Results: Dorsal commissural flaps were the initial operative approach in 100% of the complex/complicated cases, whereas Z-plasties were used in 64% of the simple cases. Full-thickness skin grafts were required in 12 (86%) of the complex/complicated cases and in 14 (26%) of the simple cases. Additional procedures such as amputation or osteotomy were performed in five complex/complicated (36%) and five simple (9.1%) cases. Range-of-motion deficits were the most common complication (26%), and 20 (29%) cases required revision surgery. Conclusions: Patients with first web syndactyly often require multiple operations and concurrent procedures on the index finger and thumb to optimize hand function. Reconstruction should be personalized to each patient's unique clinical presentation. Type of study/level of evidence: Prognosis IIb.