Background: Pediatric syndactyly is a common congenital hand anomaly that may impair both function and appearance. Various surgical techniques have been proposed; however, the optimal reconstructive approach remains controversial. This systematic review evaluated recent clinical evidence regarding surgical outcomes, complications, and contemporary reconstructive strategies in pediatric syndactyly.

Methods: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library was performed for clinical studies published between January 2010 to March 2026. Studies assessing functional, aesthetic, or postoperative outcomes following pediatric syndactyly surgery were included. Data extraction and quality assessment were conducted independently by two reviewers.

Results: Ten eligible clinical studies were included. Conventional skin grafting remained the most commonly reported technique, although flap-based and graftless approaches have increasingly been utilized in recent years. Flap reconstruction and dermal substitute–assisted procedures were generally associated with lower rates of web creep, hypertrophic scarring, and donor-site morbidity compared with traditional grafting methods. Nevertheless, postoperative complications, particularly scar contracture and recurrent web creep, remained frequent in complex and syndromic cases. Considerable heterogeneity in surgical techniques and outcome assessment limited direct comparison among studies.

Conclusions: Current evidence suggests that flap-based and graft-sparing techniques may provide improved functional and aesthetic outcomes with fewer complications compared with conventional grafting approaches. However, high-quality prospective multicenter studies with standardized outcome measures are still required to establish evidence-based surgical guidelines for pediatric syndactyly reconstruction