Abstract: Introduction: Dorsal hand skin flaps have been described in order to avoid digit skin grafting in syndactyly release. Although these skin-graftless techniques present a lower rate of long term complications, they result in unsightly dorsal scarring and worse patient satisfaction. We describe a novel technique using an intermetacarpal palmar flap by performing an anatomic study and clinical application. Materials and Methods: Ten colored-latex-injected fresh upper limbs were used to study the palmar cutaneous perforators to second to fourth intermetacarpal space skin flaps designed elliptical, its width extending from the center of each involved ray and measuring 40%?50% the length of the palm. Results: The anatomical study revealed a mean 2.77 (range 1 to 4) cutaneous perfo rators originating from either the common or proper digital vessels for every interme tacarpal space and measuring 0.4 mm (range 0.3 to 0.5 mm) in diameter. Clinical Application: This flap, measuring a mean of 21.5 mm (range 20 to 23 mm) in length and 9.5 mm (range 9 to 10 mm) in width, was used to release simple syndac tylies in three patients of mean age 24 months (range = 18?30 months). After skin incision, cutaneous septa to the digital canal were released to permit flap advance ment to the web space. Cutaneous perforators were not dissected. Intra-operative palmar-flap advancement provided commissure coverage in all children with no skin grafts needed. Over a mean follow-up of 15 months, no complications occurred, mean palm scar VSS was 2.4 (range 2 to 3) while it was 3 (range 3 to 3) for the com missure scars. Conclusions: Skin-graftless syndactyly release using a palmar intermetacarpal flap seems both reliable and easy-to-perform. Level of Evidence: Therapeutic IV.
