Correction of Symbrachydactyly A systematic review of surgical options

Abstract Background: There are numerous treatment options available for Symbrachydactyly, a condition with a large spectrum of severity, such as a non-vascularized toe-phalanx transfer, a vascularized toe-to-hand transfer, web-syndactyly release, and distraction lengthening. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes. Methods: The review was performed according to the PRISMA guidelines. Literature was systematically assessed up to 12/2021. Studies were identified using synonyms for ‘symbrachydactyly’ and ‘treatment’. Results: 23 studies published between 1988 and 2021 were included with 539 patients (1037 digit corrections). 8 studies looked at non-vascularized toe to hand transfer, 8 covered vascularized toe to hand transfer, 5 examined distraction osteogenesis only, and 3 exclusively looked at web release. No clear strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates. Non-vascularized transfer demonstrate higher donor site complications, whereas vascularized transfers show higher vascular complication and revision rates in the hand. Conclusion: Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactly due to inadequate study designs and comparative studies. Based on the available evidence we suggest a treatment protocol. As an alternative perspective, it is important to mention that tissue engineering and regenerative medicine might provide alternative surgical solutions in the future, overcoming the issues of morbidity at harvest site and limited supply of autologous phalanges. Systematic review registration: National Institute for Health Research PROSPERO International prospective register of systematic reviews Nr: CRD42020153590