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This is a systematic review journal, published at 2017 in American journal of hand surgery ,

that compare about the outcomes following simple syndactyly reconstruction with skin grafts
or a dorsal metacarpal advancement flap. The authors come from Division of Plastic Surgery,
Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg
School of Medicine, Chicago.

The author did literature search in PubMed, EMBASE, MEDLINE, and Google Scholar using
selected keywords that has been mentioned before, that published between January 1966 and
January 2016. The exclusion criteria that has been used are the cases that were not clearly
differentiated by technique or type of simple syndactyly or the case of complex syndactyly.
The inclusions criteria are the English language papers that reported on simple syndactyly and
involved treatment by skin graft procedure or a dorsal metacarpal advancement flap. the author
then reviewed the articles and performed manual reference check. The data then extracted and

PICO of this journal are

- P: Patient with simple syndactyly
- I: Treated with involvement of skin graft procedure
- C: Treated with involvement of a dorsal metacarpal advancement flap
- O: Complication and need for revision; and when stratified by syndactyly type (complete
and incomplete) also assessed for hypertrophic scarring rate.

There are 673 citations at the primary search, and after the screening and reviewed, there are
34 studies that match the criteria, composed of 991 patients and 17144 webs. The authors
calculated odd ratio to compare complication rates after each technique, and chi square analysis
to compare categorical outcomes. The outcomes are early postoperative complications
(infection, flap necrosis/ graft failure), contracture, hypertrophic scar, and revision surgery.
The result of this journal are:
1. Flap necrosis/graft failure has odd ratio at 4 times, with 95% confidence interval with p
value less than 0,05. (OR, 4.0; 95% CI; P < 0.05) and combined early complications (OR,
9.4; 95% CI, P < .05) were significantly more likely to occur in the graft group.
2. Web creep was significantly more likely to occur in the graft group (OR, 12.9; 95% CI; P <
3. Contracture was significantly more likely to occur in the graft group (OR, 4.5; 95% CI; P <
4. Scar hypertrophy was significantly more likely to occur after graft procedures in all simple
webs (OR, 49.3; 95% CI; P < 0.05)
5. Revision surgery/web and revision surgery/patient were significantly more likely to occur
after graft procedures in the overall study group (OR, 14.5; 95% CI; P < .05 and OR, 10.5;
95% CI; P < .05, respectively)

The author concluded that skin grafts procedure for reconstruction of simple syndactyly may
lead to higher complications than a dorsal metacarpal advancement flap procedure. However,
the current available evidence still not adequate enough to give a recommendation to specific
technique. Therefore the future research that use a uniform reporting system for syndactyly
classification and complications is needed.