Creation of a Natural Interdigital Web in Toe Polysyndactyly With a Dorsal Trapezoidal and Plantar Triangular Flap Design

Surgical correction of polysyndactyly of the toes requires not only functional separation of the digits but also creation of an aesthetically acceptable interdigital web, as postoperative appearance strongly affects psychosocial outcomes. Although traditional techniques, including Z-plasty and dorsal rectangular flaps as well as web-preserving flaps with or without skin grafting, have been described, complications such as web creep, wound dehiscence, and valgus deformity of the residual toes remain problematic. Here, we report a case of polysyndactyly involving the fourth, fifth, and sixth toes of the left foot in a five-year-old girl. A trapezoidal dorsal rectangular flap was created in the fourth interdigital space and combined with a triangular plantar flap to achieve a web that was narrow in the mid-portion and broader at the base. The dorsal flap base and plantar inset were advanced 2 mm proximally to enhance web depth. Residual skin defects were covered using a full-thickness skin graft harvested from the medial malleolar region. Six months postoperatively, the reconstructed web showed appropriate depth, tapering, and alignment consistent with the adjacent interdigital spaces. No valgus deviation was observed in the residual toes. The skin graft demonstrated excellent take with only minor pigmentation differences and no significant scar contracture or web creep. The patient's postoperative function and ambulation were uneventful. The combination of a trapezoidal dorsal rectangular flap and plantar triangular flap with proximal advancement of the inset facilitates the creation of a deep and natural-appearing interdigital web. Adjunctive full-thickness skin grafting allows tension-free closure of larger skin deficits, reducing the risk of secondary complications. Although this report describes a single case, the technique may be useful in the aesthetic reconstruction of polysyndactyly of the toes.