Syndactyly, a common hand anomaly, is often treated by plastic surgeons through various surgical techniques. Over 46 corrective procedures have been described since the 1800s, with approaches varying in flap designs and the use of skin grafts. Some studies have suggested that graftless techniques may reduce operative time and postoperative complications. This study aims to evaluate the use of a local "hexagonal" dorsal advancement flap (HDAF) for syndactyly repair, specifically focusing on a graftless technique.

Between March 2021 and March 2022, 18 patients (25 web spaces) with congenital, recurrent, or post-burn syndactyly underwent surgery at Rizgary and Hawler teaching hospitals in Erbil. The study assessed the early outcomes of using the HDAF combined with straight-line incisions for finger separation. Patient ages ranged from 1.5 to 50 years, with a mean follow-up period of 6.3 months (1-13 months). The average operation time was 98.5 minutes (ranging from 40 to 160 minutes). Primary closure of wounds without the use of skin grafts was achieved in 96% of cases. No flap loss or recurrence of syndactyly occurred. The mean abduction angle achieved post-surgery was 36.5º. Additionally, all patients and caregivers reported satisfaction with the aesthetic outcomes.

In conclusion, the hexagonal dorsal advancement flap (HDAF) combined with straight-line separation is a safe, efficient, and aesthetically favorable technique for syndactyly repair. It offers a relatively short surgical procedure, avoids the use of skin grafts, and yields good functional and cosmetic results. The technique proves effective across various ages and syndactyly types, making it a reliable option for hand surgeons.