Syndactyly

Syndactyly

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Syndactyly is abnormal connection of two fingers or toes. Mostly it is webbing between middle and ring finger. It can also involve more than two fingers.

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What are different types of syndactyly?

  • Incomplete: Just part of fingers is involved.
  • Complete: Involves complete fingers all the way to the tips.
  • Simple/Cutaneous: Only skin connection between the fingers
  • Complex: Includes bony interconnections between the fingers.
  • Complicated: usually associated with the syndrome.
  • Acro syndactyly: Fingers are fused towards the tip and they are free at the web space.
  • Symbrachydactyly: Fingers are short and webbed

Why to consult a Plastic surgeon?

Problem in syndactyly is grabbing large or circular or large object. The hand looks different. This may bother the child and may change how others relate to child. This may lead to stress and decrease self-esteem. The only way to correct is through surgery by board certified Plastic surgeon.

Separating fingers is not as simple as cutting the skin and connecting the fingers because there is not enough skin. Syndactyly must be corrected through series of carefully designed flaps. Some require skin graft. Kids are placed in bulky soft dressing until 2 weeks after surgery and then they start physiotherapy. Physiotherapy is as important as surgery to keep the scar soft and maintain range of motion.

When to perform surgery for syndactyly?

Timing of surgery depends on many factors. When it involves thumb & index finger or ring & little finger it is better to perform surgery between 9 to 12 months of age. Other syndactyly’s can be treated when the child is older (18 months to 3 years).

FAQ's

Most of the surgeries are uneventful and child behaves well with good function and satisfactory appearance after surgery. However, infection, web creeping, non-survival of skin grafts and flaps are some of the possible risks. Some children may need second surgery.

It is scarring in the commissure between the fingers that leads to partial recurrence of syndactyly.

Usually only one surgery is needed that affects only two fingers. Some patients may need second surgery most commonly to deal with web creeping.

The skin surrounding two joint fingers is not enough to cover the fingers when they are separate. A straight-line incision tends to scar in a band which contracts over a period of time. Skin at the base of the finger(commissure) is most likely to scar and must be reconstructed most carefully to look near normal.

Most of the raw area created after separation of fingers is covered by the local flaps. Some area if at all needed is covered with full thickness skin graft. Donor sites for skin graft are Groin, front of wrist and elbow.

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