549 Foot Syndactyly: Operative Management, Postoperative Webspace Splinting, and a Retrospective Review of Cases Across 15 Years at a Tertiary Plastics Centre

Aim

Syndactyly of the foot is a common congenital abnormality, with an estimated prevalence of 1 in 2,000. While thought to be more common than hand syndactyly, there is considerably less discussion of foot syndactyly in the literature. We describe our operative approach to foot syndactyly and a postoperative technique for splinting with silicone moulds to reduce webcreep complication. We sought to further characterise the nature of, and postoperative outcomes for, foot syndactyly cases managed at our centre.

Method

We performed a retrospective analysis of cases of paediatric foot syndactyly managed at our centre over the last 15 years.

Results

47 patients (52 primary foot syndactyly repair operations), involving 75 webspaces were identified (80.0% simple syndactyly, 1.3% complex, 18.7% not specified). 54.7% webspaces were incomplete syndactyly (21.3% complete, 24.0% not specified). The second webspace was the most commonly involved (57.3%). Median age of first operation was 47.5 months.

Of patients with documented follow-up, 24.1% of webspaces developed a complication. Complications included webcreep (13.8%), keloid (5.2%) and hypertrophic (5.2%) scarring, graft loss (3.4%), infection (3.4%), overgranulation (1.7%), clinodactyly (1.7%), and suture granuloma (1.7%). The most common documented repair technique involved ‘V-shaped’/’triangular’ interdigitating local flaps. There was no difference in webcreep rates between FTSG and STSG repairs.

Conclusions

Webcreep remains the most common complication of foot syndactyly, and one parents must be suitably informed about. This work adds to a relatively small body of work internationally and describes a simple method to help reduce post-operative contracture.