Consider the foreskin for syndactyly repair

An account of 3 case studies illustrates how preputial skin may be an ideal graft for repairing syndactyly because the tissue is easily accessed and harvested and is hairless and free of subcutaneous fat; the procedure also is associated with low morbidity/mortality. Syndactyly release generally is performed with full thickness skin grafts from the groin region, which can result in growth of unwanted hair and subcutaneous fat.

The 3 patients, referred to urology at the request of the orthopedic surgeon, underwent circumcision at the time of syndactyly repair to provide preputial skin for graft coverage. The infants were 17-, 18- and 20-months-old, respectively, when they underwent the surgery. The skin grafts healed well in all 3 infants, and though the grafts were associated with some increased pigmentation, parents were satisfied with the outcomes. Given these results, the authors recommend “careful assessment for congenital anomalies that may require skin grafting, such as syndactyl, prior to ‘routine’ neonatal circumcision” (Romeus L, et al. J Pediatr Urol. 2020; Epub ahead of print).

Thoughts from Dr. Farber

This strikes me as a brilliant concept, another surgical reason, besides hypospadias, for sparing the foreskin. Please remember this, or inform your obstetrical colleagues, before doing a circumcision in a boy with syndactyly.