T ISSUE EXPANSION FOR APERT 'S SYNDACTYLY

Tissue expansion is useful in post-traumatic reconstruction in the upper extremity. Its use has also been proposed in congenital syndactyly. Expanded local skin flaps would in theory provide locally appropriate cover, obviating the need for skin grafts. We report a retrospective assessment of tissue expansion in the management of Apert's syndactyly.:Despite theoretical benefits, tissue expansion significantly increased the required number of operations. The technique was associated with an unacceptable rate of complications, and generated inadequate skin flaps, and web spaces requiring a higher rate of revision than traditional techniques. Despite expectations, tissue expan-sion for Apert's syndactyly proved disappointing and is not advocated. Journal of Hand Surgery (British and European Volume, 1995) 20B: 3:327-330 In the reconstruction f congenital syndactyly, local soft tissues are rarely adequate to allow direct closure of the separated igits. Although skin grafts will fill the resulting skin defects, they are not a perfect solution to the problem. Infection, haematoma, nd motion may interfere with graft take, and scar contraction and graft pigmentation may compromise functional andaesthetic outcomes. Some defects, for example where there is bone or joint exposure, are not amenable to simple grafting. Preliminary skeletal separation with silicone sheeting (Stefansson and Stilwell, t 994) may allow graft-ing of these wounds at final separation. Distant skin flaps such as the groin flap (Zuker et al, 1991) or the reverse radial forearm island flap (Fereshetian and Upton, 1991) may be used, but expansion of adjacent skin presents an appealing alternative. Reported expan-sion techniques have included the web space 'pincer' (Ogawa et al, 1989), a transosseous distraction appar-atus (Gudushauri and Tvaliashvili, 1991), and sub-cutaneous balloons (Borenstein et al, 1991; Morgan and Edgerton, 1985; Coombs, 1994). The first tw