Surgical Technique for Camptodactyly Treatment

A tongue-shaped flap was created on the radial wall of the 5th digit, with the longitudinal edges not exceeding the radial surface of the digit, and the distal edge made slightly beyond the PIP joint line. To ensure full coverage of the volar skin defect, the flap was made 2 mm larger in diameter than the recipient site (Fig. 2).Figure 2

Representative illustrations of camptodactyly of the 5th digit. (a) Frontal and lateral views of the 5th digit before surgery. (b) Design of the tongue-shaped flap, with the longitudinal edges limited within the radial surface, and the distal edge made slightly exceeding the proximal interphalangeal joint line. (c) The volar incision. (d) The lateral view of the digit flap transfer, with direct suturing performed for closure of the donor site. (e) The volar view of the digit after flap transfer, with complete coverage of the volar skin defect.

While creating the edges of the flap, care was taken to preserve the perforating blood vessels of the proper palmar digital arteries, as well as the proper palmar digital nerves.
Sequential release of affected soft tissues was performed in the following order—skin, subcutaneous fibrous fascia, flexor digitorum superficialis tendon, lumbrical muscle insertions if present, and volar plate. The degree of passive extension of the PIP joint was repeatedly tested, and surgical release was considered complete upon achieving full passive extension of the joint. Kirschner (K)-wire fixation was performed following volar plate release.
The radial flap was rotated 90° to cover the volar skin defect, and direct suturing was performed to close the donor site. Free skin grafting was indicated in the presence of high suture tension.
Mupirocin ointment and petroleum jelly (Vaseline) were subsequently applied, and the wound was wrapped with clean dressing. All digits were immobilized in the extended position with a cast for three weeks.