Children born with Apert acrocephalosyndactyly pose great challenges to the 
pediatric hand surgeon. Reconstructive dilemmas consist of shortened, deviated 
phalanges and extensive skin deficits following syndactyly release. We present a 
10-year review of patients with Apert acrocephalosyndactyly who were treated 
with a simplified surgical approach. Between 1986 and 1996, 10 patients with 
Apert syndrome underwent reconstructive surgery of their hands. The overall 
strategy involved early bilateral separation of syndactylous border digits at 1 
year of age, followed by sequential unilateral middle syndactyly mass separation 
with thumb osteotomy and bone grafting as needed. In these 10 patients, a total 
of 53 web spaces were released, 49 of which involved osteotomies for complex 
syndactyly. Only local flaps and full-thickness skin grafts from the groin were 
used in all cases to achieve soft-tissue coverage. To date, seven of the 53 web 
spaces have needed revision (revision rate, 13 percent). Eleven thumb 
osteotomies (nine opening wedge and two closing wedge) were performed. Bone 
grafts from the proximal ulna or from other digits were used in all cases. To 
date, none of these thumb osteotomies have needed revision. This early, 
simplified approach to the complex hand anomalies of Apert acrocephalosyndactyly 
has been successful in achieving low revision rates and excellent functional 
outcomes as measured by gross grasp and pinch and by patient and parent 
satisfaction.