Surgical Management of Pediatric Syndactyly: A Systematic Review of Techniques, Outcomes, and Complications

Keikha, Yaghoob; Nourmohammadi, Jalal; Rezaeian, Amin

doi:10.22038/jpp.2026.95705.5657

Surgical Management of Pediatric Syndactyly: A Systematic Review of Techniques, Outcomes, and Complications

Document Type : systematic review

Authors

Yaghoob Keikha ¹

Jalal Nourmohammadi ²

Amin Rezaeian ¹

¹ Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

² Student Research Committee, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran.

10.22038/jpp.2026.95705.5657

Abstract

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.

Keywords

Dermal Substitutes

Flap Techniques

Graftless Surgery

Hand Reconstruction

Pediatric Syndactyly

Surgical Outcomes

1. Zaib T, Rashid H, Khan H, Zhou X, Sun P. Recent advances in syndactyly: Basis, current status and future perspectives. Genes. 2022 Apr 27;13(5):771.

2. Malik S. Syndactyly: phenotypes, genetics and current classification. European Journal of Human Genetics. 2012 Aug;20(8):817-24.

3. McCarter JH, Zeledon RA, Cole SH, Layon SA, Nguyen JL. Common pediatric hand anomalies. InSeminars in Plastic Surgery 2023 Nov (Vol. 37, No. 04, pp. 275-286). Thieme Medical Publishers, Inc.

4. Schirlo JM, Saad Cleto A, Beltrame D, Beltrame M, Scortegagna T, Marinelli Martins C. Comparison between surgical techniques for correction of congenital syndactyly: a systematic review and meta-analysis. HAND. 2025;20(4):523-32.

5. Bartsch A, Nikkhah D, Miller R, Mende K, Hovius SE, Kaempfen A. Correction of symbrachydactyly: a systematic review of surgical options. Systematic Reviews. 2023 Nov 16;12(1):218.

6. Putri IL, Sindhu FC, Aisyah IF, Pramanasari R, Wungu CD. Comparison of combination skin substitutes and skin grafts versus skin grafts only for treating wounds measured by Vancouver Scar Scale: a comprehensive meta-analysis. SAGE Open Medicine. 2024 Jul;12:20503121241266342.

7. Patel NK, Toyoda Y, Grunzweig KA, Shah AS, Mendenhall SD. Recent advancements in the diagnosis and treatment of congenital hand differences. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2023 Aug 1;31(15):766-82.

8. Phan MD, Truong QH, Nguyen TT, Thi DM, Nguyen PD. Optimizing surgical outcomes in congenital syndactyly: Evaluation of flap and graft techniques in older pediatric patients. Cureus. 2024 Jul 15;16(7).

9. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021 Mar 29;372.

10. Nietosvaara N, Kämppä N, Nietosvaara Y, Grahn P. Long-term patient reported outcomes and quality of life after syndactyly separation. Journal of Hand Surgery (European Volume). 2026 Feb;51(2):202-8.

11. Sullivan MA, Adkinson JM. A systematic review and comparison of outcomes following simple syndactyly reconstruction with skin grafts or a dorsal metacarpal advancement flap. The Journal of Hand Surgery. 2017 Jan 1;42(1):34-40.

12. Fangxing A, Gongchi L, Zhiwei L, Hanling L, Haiding Z, Yuxiong W, et al. Syndactyly release with the use of the Pelnac™ artificial dermal substitute without skin grafting. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2023 Sep 1;84:115-20.

13. Bickham RS, Waljee JF, Chung KC, Adkinson JM. Postoperative patient-and parent-reported outcomes for children with congenital hand differences: a systematic review. Plastic and reconstructive surgery. 2017 Jun 1;139(6):1422-9.

14. Mende K, Watson A, Stewart DA. Surgical treatment and outcomes of syndactyly: a systematic review. The Journal of Hand Surgery (Asian-Pacific Volume). 2020 Mar;25(01):1-2.

15. Langlais T, Rougereau G, Marty-Diloy T, Bachy M, Barret H, Vialle R, et al. Surgical treatment in child’s congenital toe syndactyly: Risk factor of recurrence, complication and poor clinical outcomes. Foot and Ankle Surgery. 2022 Jan 1;28(1):107-13.

16. Wall LB, Velicki K, Roberts S, Goldfarb CA. Outcomes of pediatric syndactyly repair using synthetic dermal substitute. The Journal of Hand Surgery. 2020 Aug 1;45(8):773-e1.

17. Bohn DC, Price JN, Novotny SA, Sylvanus TS, Van Heest AE. Syndactyly release with skin graft or skin graft substitute: a within-subject controlled trial. Journal of Hand Surgery (European Volume). 2025 Nov;50(10):1339-47.

18. Chouairi F, Mercier MR, Persing JS, Gabrick KS, Clune J, Alperovich M. National patterns in surgical management of syndactyly: a review of 956 cases. Hand. 2020 Sep;15(5):666-73.

19. Yu W, Yang G, Yin F, Yin C, Yang W, Chan PT, et al. A new concept of webspace reconstruction in syndactyly-An easily reproducible cross-shaped advancement flap. Journal of hand and microsurgery. 2024 Oct 1;16(4):100081.

20. Yoon AP, Jones NF. Interdigitating rectangular flaps and dorsal pentagonal island flap for syndactyly release. The Journal of Hand Surgery. 2019 Apr 1;44(4):288-95.

21. Senda E, Ueda K, Hirota Y, Mitsuno D, Nuri T. Using Dermal Fat Graft to Release Complex Syndactyly: A New Method. Plastic and Reconstructive Surgery–Global Open. 2020 Aug 1;8(8):e3068.

22. Romeus L, Liu C, Stanton R, Ellsworth P. Routine circumcision? The role of prepuce in syndactyly repair. Journal of Pediatric Urology. 2020 Aug 1;16(4):497-9.

23. Mahmoud WH. Simple syndactyly reconstruction with dorsal metacarpal artery perforator-based propeller flap. European Journal of Plastic Surgery. 2022 Apr;45(2):307-14.

24. Wall LB, Goldfarb CA. Syndactyly reconstruction technique utilizing skin substitute. Techniques in Hand & Upper Extremity Surgery. 2024 Jun 1;28(2):60-1.

25. Le Hanneur M, Cambon-Binder A, Bachy M, Fitoussi F. Treatment of congenital syndactyly. Hand Surgery and Rehabilitation. 2020 May 1;39(3):143-53.

26. Harbuzniak IM, Hrуtsenko A. Features of surgical correction of various forms of hand syndactyly in children. Retrospective study of own treatment experience. Orthopaedics, Traumatology and Prosthetics. 2021(2):5-9.

27. Ferrari BR, Werker PM. A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction?. Journal of Hand Surgery (European Volume). 2019 Mar;44(3):296-303.

28. Elrod J, Moellmeier D, Schiestl C, Mohr C, Neuhaus K. Comparative analysis of functional and aesthetic outcomes of retroauricular full thickness versus plantar glabrous split thickness skin grafts in pediatric palmar hand burns. Burns. 2020 May 1;46(3):639-46.

29. Shah R, Rodrigues R, Phillips V, Khatib M. The use of artificial dermal substitutes for repair of the donor site following harvesting of a radial forearm free flap: A systematic review. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2024 Jan 1;88:501-16.

30. Cordray H, Graham EM, Kota A, Shah AS, Chang B, Mendenhall SD. Clinical and operative risk factors for complications after Apert hand syndactyly reconstruction. Journal of Hand Surgery (European Volume). 2024 May;49(5):617-26.

31. Di Giuli R, Dicorato P, Kaciulyte J, Marinari N, Conversi F, Mazzocchi M. Donor site wound healing in radial forearm flap: a comparative study between dermal substitute and split-thickness skin graft versus full-thickness skin graft primary coverage. Annals of Plastic Surgery. 2021 Jun 1;86(6):655-60.

32. Raposo-Amaral CE, Medeiros LL, Raposo-Amaral CA. Apert syndrome type III hand: prevalence and outcomes. Journal of Craniofacial Surgery. 2023 Jun 1;34(4):1170-3.

33. Bartsch A, Nikkhah D, Miller R, Mende K, Hovius SE, et al. Correction of symbrachydactyly: a systematic review of surgical options. Systematic Reviews. 2023 Nov 16;12(1):218.

34. Lohmeyer JA, Hülsemann W, Mann M, Habenicht R. Transverse soft tissue distraction preceding separation of complex syndactylies. Journal of Hand Surgery (European Volume). 2016 Mar;41(3):308-14.

35. Artioli E, Cargeli A, Mazzotti A, Zielli SO, Arceri A, Langone L, et al. Surgical management of foot syndactyly: the state of the art and a treatment algorithm based on a literature review. Journal of Clinical Medicine. 2025 Jan 27;14(3):830.

36. Seligman WH, Das-Gupta Z, Jobi-Odeneye AO, Arbelo E, Banerjee A, Bollmann A, et al. Development of an international standard set of outcome measures for patients with atrial fibrillation: a report of the International Consortium for Health Outcomes Measurement (ICHOM) atrial fibrillation working group. European Heart Journal. 2020 Mar 7;41(10):1132-40.

37. Belardo ZE, Graham EM, Pehnke M, Chang B, Mendenhall SD, Mori S, et al. Revision surgery following primary reconstruction for hand syndactyly. The Journal of Hand Surgery. 2024 Dec 1;49(12):1228-38.