ABSTRACT
We strongly advocate the avoidance of interdigital skin grafts when treating syndactyly. These grafts become dark brown and give a ‘dirty’ appearance. Sometimes they extend toward the palmar side of the hand, and always become dark. Raymond Vilain refers to this as a ‘Lady Macbeth’ sign, because she had a brown spot, ghoulish, in her palm, as a sign of her guilt. It always seems more elegant to use simple Z-plasty,
or a trident flap, or a dorsal lateral finger flap turned in the palmar area, thus leaving the raw areas for spontaneous healing without any flap. This technique has given us many satisfactory results and has been published by several authors. Spontaneous healing in a child allows easy coverage
of the lateral, and even dorsolateral side of the operated fingers, but only if care has been taken not to expose extensor and flexor tendons and the collateral
vasculonervous bundle; they should remain covered by their perimysium layer. It is indeed during the primary dissection when sepa-
rating the fingers that careful attention should be paid. This is an actual advance. In the future, no grafting
should be used for repair in any case of syndactyly, be it in the hand or in the foot. We have already used this method in adults with the same good results. Nail disorders in children are beyond the scope of this
chapter. However, we have to admit that total nail reconstruction is a very difficult project, especially in children, where the anatomical structures are minute, delicate, and may even be destroyed in some cases of whitlow.
