Brilish Journal of Plastic Surgery (1984) 37,3 l-34 B 1984 The Trustees of British Association of Plastic Surgeons

A fortuitous donor site for full-thickness skin grafts in the correction of syndactyly

A. R. ROWSELL and A. M. GODFREY

Department of Plastic Surgery, Radcliffe Infirmary, Oxford

Summary-The ideal donor site for full-thickness skin grafts to the non hair-bearing areas of the fingers is the glabrous skin of other digits, The use of these sites is usually restricted because of the limited amount of skin available and the donor site morbidity. We were recently presented with a clinical situation in which one congenital abnormality of the fingers requiring full-thickness skin grafts for its correction was associated with another congenital abnormality of the digits: amputation of the supernumerary fingers and toes provided the ideal donor site for the full-thickness skin grafts needed in the hand.

In 1875 Wolfe described the use of a full-thickness many donor sites have been described with increas- skin graft to resurface a lower eyelid. The donor ing emphasis on the principle of matching the site on that occasion was the forearm. Since then properties of the donor site skin to that of the

Figure I-(A) Polydactyly of both hands and syndactyly of the ring and little fingers of the right hand. (B) Polydactyly of both feet.

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32 BRITISH JOURNAL OF PLASTIC SURGERY

Figu re 2-The z :xcised supernum erary digits from both hands and feet.

Fig. 2

recipient site. This principle has been applied successfully to full-thickness skin grafts on the face. Naso-labial skin grafts have been described for defects on the nasal tip (Beare and Bennett, 1972), and pre-auricular skin has been used for defects in the medial canthal/nose and eyelid/cheek areas (Breach, 1978).

The principle of accurately matching the skin properties of the donor site with the recipient site has met with only limited success in the hand. The skin on the volar aspect of the hands and fingers is of a specialised nature and is best replaced by donor skin with similar properties. This is available only from hands, feet and digits (Dellon, 1981). Although the successful use of full-thickness skin grafts taken from the palm to cover defects of the fingers has been described (Lie et al., 1970) the limited amount of skin available and the donor site morbidity would normally preclude the use of these areas as donor sites.

Case report In November 1982 a 2-year-old girl was admitted to the Plastic Surgery Unit at the Radcliffe Infirmary with syndactyly of the ring and little fingers on the right hand and polydactyly of both feet and both hands (Fig. 1).

Under general anaesthetic and tourniquet control all the supernumerary digits were excised (Fig. 2). The syndactyly of the right fourth web space was corrected using a modified Bauer’s technique (Bauer et al., 1956). The rectangular dorsal flap and the interdigitating triangular flaps on the adjacent surfaces of the ring and little fingers were sutured into position and templates of the residual defects on the adjacent surfaces of the two fingers were made. Appropriately shaped full-thickness skin grafts were then harvested from the excised digits and sewn into position (Fig. 3). The child was discharged on the second post-operative day and the sutures removed on the seventh post-operative day.

There was 100% take of all the full-thickness skin grafts and 6 months later the child was able to demon- strate a full range of movements of the little and ring fingers of the right hand (Fig. 4).

A FORTUITOUS DONOR SITE FOR FULL-THICKNESS SKIN GRAFTS IN THE CORRECTION OF SYNDACTYLY 33

Fig. 3

Figure 3-(A) Residual defects on adjacent fingers after correction of the web space. (B) Full-thickness skin grafts sewn into position.

Fig yre 4-Result 6 months later showing an excellent cosmetic result and full extension of the separated digit.

Fig. 4

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References

Bauer, T. B., Tondra, J. M. and Trusler, H. M. (1956). Technical modification in repair of syndactylism. Plastic and Reconstructive Surgery, 17,385.

Beare, R. L. B. and Bennett, 1. P. (1972). The naso-labial full-thickness graft. British Journal of Plastic Surgery, 25, 315.

Breach, N. M. (1978). Pre-auricular full-thickness skin grafts. British Journal of Plastic Surgery, 31, 124.

Dellon, A. L. (1981). Evaluation of Sensibility and Re- Education of Sensation in rhe Hand. Baltimore: Williams & Wilkins Company.

Lie, K. K., Margarle, R. K. and Posch, J. L. (1970). Free full-thickness skin grafts from the palm to cover defects of the fingers. Journal of Bone and Joint Surgery, 52-A, 559.

Wolfe, J. R. (1895). A new method of performing plastic operations. British Medical Journal, 2, 360.

The Authors

A. R. Rowsell, FRCS, FRACS, Senior Registrar in Plastic Surgery, Radcliffe Infirmary, Oxford.

A. M. Godfrey, FRCS, Consultant Plastic Surgeon, Radcliffe Infirmary, Oxford.

Requests for reprints to: A. R. Rowsell, FRCS, FRACS, Department of Plastic Surgery, Radcliffe Infirmary, Oxford OX2 6HE.