{"id":707,"date":"2025-11-28T23:31:02","date_gmt":"2025-11-28T23:31:02","guid":{"rendered":"https:\/\/mbiportfolio.com\/JamieHefley\/?p=707"},"modified":"2026-01-06T05:39:04","modified_gmt":"2026-01-06T05:39:04","slug":"complete-complex-syndactyly-release","status":"publish","type":"post","link":"https:\/\/mbiportfolio.com\/JamieHefley\/complete-complex-syndactyly-release\/","title":{"rendered":"Syndactyly Release and Reconstruction"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"707\" class=\"elementor elementor-707\">\n\t\t\t\t<div class=\"elementor-element elementor-element-33243420 e-flex e-con-boxed e-con e-parent\" data-id=\"33243420\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-70d6b724 elementor-widget__width-initial elementor-widget-tablet__width-initial elementor-widget-mobile__width-initial elementor-widget elementor-widget-image\" data-id=\"70d6b724\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1978\" height=\"2560\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/09\/Hefley_Surg1-scaled.jpg\" class=\"attachment-full size-full wp-image-1398\" alt=\"\" srcset=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/09\/Hefley_Surg1-scaled.jpg 1978w, https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/09\/Hefley_Surg1-464x600.jpg 464w, https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/09\/Hefley_Surg1-791x1024.jpg 791w, https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/09\/Hefley_Surg1-768x994.jpg 768w, https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/09\/Hefley_Surg1-1187x1536.jpg 1187w, https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/09\/Hefley_Surg1-1583x2048.jpg 1583w\" sizes=\"(max-width: 1978px) 100vw, 1978px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3828d1b1 e-con-full e-flex e-con e-child\" data-id=\"3828d1b1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2ef3ac1f elementor-widget elementor-widget-heading\" data-id=\"2ef3ac1f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Syndactyly Release and Reconstruction<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2d3d9876 elementor-widget elementor-widget-text-editor\" data-id=\"2d3d9876\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>YEAR<\/strong><\/p><p>2025<\/p><p>\u00a0<\/p><p><strong>CLIENT<\/strong><\/p><p>Cory Sandone, MA, CMI<\/p><p>Dr. Scott Lifchez, MD<\/p><p>Johns Hopkins Department of Plastic and Reconstructive Surgery<\/p><p>\u00a0<\/p><p><strong>MEDIA<\/strong><\/p><p>Graphite\u00a0 |\u00a0 Photoshop<\/p><p>\u00a0<\/p><p><strong>DESCRIPTION<\/strong><\/p><p><span style=\"font-weight: 400;\">Syndactyly is a congenital condition in which two or more fingers do not fully separate during development, leaving them fused. Surgical release is typically performed between 12 and 18 months of age to support normal growth and function. The patient observed was 5 years old and presented with bilateral complete complex syndactyly of the fourth and fifth digits or ring and small finger. This means fusion extended to the fingertips involving a bony connection. The patient also had simple incomplete syndactyly between the third and fourth digits. Due to the length disparity between the ring and small fingers, their separation is prioritized to prevent progressive angular deformity and soft-tissue tension. Release of the middle and ring fingers will be planned for a future procedure.<\/span><\/p><p><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">For this illustration, I rendered a few of the key reconstruction steps beginning with an orientation of the planned incisions for flap creation. I chose to render in grayscale and rely on contrast and shading for clear visualization of flap design and tissue planes which I thought color would distract from.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8fd4f11 e-con-full e-flex e-con e-parent\" data-id=\"8fd4f11\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5fe44c elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"a5fe44c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ea1dba4 elementor-widget elementor-widget-text-editor\" data-id=\"ea1dba4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>SKETCHES<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5827749 elementor-widget__width-initial elementor-arrows-position-inside elementor-pagination-position-outside elementor-widget elementor-widget-image-carousel\" data-id=\"5827749\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;slides_to_show&quot;:&quot;2&quot;,&quot;image_spacing_custom&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:8,&quot;sizes&quot;:[]},&quot;slides_to_show_tablet&quot;:&quot;1&quot;,&quot;navigation&quot;:&quot;both&quot;,&quot;speed&quot;:500}\" data-widget_type=\"image-carousel.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-image-carousel-wrapper swiper\" role=\"region\" aria-roledescription=\"carousel\" aria-label=\"Image Carousel\" dir=\"ltr\">\n\t\t\t<div class=\"elementor-image-carousel swiper-wrapper\" aria-live=\"polite\">\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"1 of 8\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/12\/Artboard-1-1-2048x1165.jpg\" alt=\"1A Dorsal planned incisions including division of the shared nail plate, creation of interdigital flaps, and design of a rectangular web hood for web-space reconstruction. 1B The palmar view demonstrates the planned paronychial flaps which are the V shaped incisions at the finger tip that will form the skin fold bordering the divided nail plate. Also detailed are interdigitating flaps, and a reverse T-shaped incision which is placed more proximally than than the native web space to account for postoperative web creep.\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"2 of 8\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/12\/Artboard-2-2048x1165.jpg\" alt=\"2A Beginning distally, an incision is made to mobilize the paronychial skin flaps followed by separation of the nail plate at the junction of the ring and small finger.  2A Skin flaps are elevated and retracted with care to preserve the epidermis, dermis, and sufficient subcutaneous fat to maintain flap viability. Interdigital flaps are raised distal to proximal on the dorsal side, followed by elevation of the palmar flaps.\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"3 of 8\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/12\/Artboard-8-2048x1165.jpg\" alt=\"Again here we appreciate the disparity in finger length.  3A indicates synostosis between the distal ring and small phalanx which is transected using bone cutters, then smoothed with a bone rasp to restore proper alignment and contour.\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"4 of 8\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/12\/Artboard-9-1-2048x1165.jpg\" alt=\"4A Using blunt dissection, the digits are separated with care taken to identify and preserve the proper digital arteries and nerves.  4B shows the completed separation.\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"5 of 8\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/12\/Artboard-11-2048x1165.jpg\" alt=\"5 The dorsal rectangular hood is advanced and inset to the reverse T-shaped incision for webspace reconstruction.\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"6 of 8\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/12\/Artboard-12-2048x1165.jpg\" alt=\"6A Interdigital flaps are advanced to their respective side of each digit, avoiding tension or vascular compromise.  6BParonychial flaps are inset and sutured forming the paronychial folds which border the nail plate.\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"7 of 8\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/09\/Artboard-13-2048x1165.jpg\" alt=\"7 A full thickness skin graft harvested from the patient\u2019s right lateral groin is divided and placed to resurface exposed aspects of the created web space.\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"8 of 8\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mbiportfolio.com\/JamieHefley\/wp-content\/uploads\/2025\/12\/Artboard-15-2048x1165.jpg\" alt=\"8  The completed reconstruction shows fully separated digits with restored web spaces. Areas of gaping are closed with simple interrupted sutures. Complete skin coverage is confirmed and fingertip perfusion is assessed.\" \/><\/figure><\/div>\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-prev\" role=\"button\" tabindex=\"0\">\n\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-chevron-left\" viewBox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M646 125C629 125 613 133 604 142L308 442C296 454 292 471 292 487 292 504 296 521 308 533L604 854C617 867 629 875 646 875 663 875 679 871 692 858 704 846 713 829 713 812 713 796 708 779 692 767L438 487 692 225C700 217 708 204 708 187 708 171 704 154 692 142 675 129 663 125 646 125Z\"><\/path><\/svg>\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-next\" role=\"button\" tabindex=\"0\">\n\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-chevron-right\" viewBox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M696 533C708 521 713 504 713 487 713 471 708 454 696 446L400 146C388 133 375 125 354 125 338 125 325 129 313 142 300 154 292 171 292 187 292 204 296 221 308 233L563 492 304 771C292 783 288 800 288 817 288 833 296 850 308 863 321 871 338 875 354 875 371 875 388 867 400 854L696 533Z\"><\/path><\/svg>\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"swiper-pagination\"><\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Syndactyly Release and Reconstruction YEAR 2025 \u00a0 CLIENT Cory Sandone, MA, CMI Dr. Scott Lifchez, MD Johns Hopkins Department of Plastic and Reconstructive Surgery \u00a0 MEDIA Graphite\u00a0 |\u00a0 Photoshop \u00a0 DESCRIPTION Syndactyly is a congenital condition in which two or more fingers do not fully separate during development, leaving them fused. Surgical release is typically [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1576,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[52],"tags":[],"class_list":["post-707","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/posts\/707","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/comments?post=707"}],"version-history":[{"count":17,"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/posts\/707\/revisions"}],"predecessor-version":[{"id":1692,"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/posts\/707\/revisions\/1692"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/media\/1576"}],"wp:attachment":[{"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/media?parent=707"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/categories?post=707"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mbiportfolio.com\/JamieHefley\/wp-json\/wp\/v2\/tags?post=707"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}