What is syndactyly?
Syndactyly literally means ‘Joined Digits’. Syndactyly happens when two or more fingers fail to completely separate during formation and development of the hand.
It can be very minor involving webbing of the skin or can involve the whole length of digits involved. In more complex forms there may be fusion of the underlying bones. It is the commonest congenital hand problem.
Why does it happen?
Though the exact cause is not known, it is combination of genetic and environmental factors that leads to this deformity.
The presentation of syndactyly can be variable. This deformity may affect either only one upper limb or involve both hands. In syndromic cases sometimes it even involves feet. The cases with involvement of multiple limbs are usually syndromic and there may be other associated deformities elsewhere in the body in these specific cases. Family history is commonly present in these types of children.
Can it be cured? What is the ideal time for treatment?
Most types of syndactyly can be improved to a great extent with surgery. To understand this, we will have to know the types of syndactyly.
‘Simple Syndactyly’ involves only skin while ‘complex’ one involves both skin and underlying bones.
Both forms can be either ‘Complete’ or ‘Incomplete’ depending upon whether it is
involving whole length of digit or only a part of it respectively.
‘Simple’ types of syndactilies can be corrected by surgery to a great extent and near normal appearance and function can be restored. ‘Complex syndactyly’ with bony only at the tip also can be completely corrected. When bony joining involves more length and joints then getting normal function is difficult.
In other form of syndactyly called 'Complicated Syndactyly', there can be many bony abnormalities in the palm, the alignment of bones may not be normal or many digits might have got stuck together, are very difficult to correct. Even if separated these digits are likely to have poor functional results.
What is ideal time for surgery?
Operation should be performed between 6 months to 2 years of age. Especially when digits of unequal lengths are fused together the longer digits’ growth is either restricted or it develops deviation to the side of smaller digit. Early separation of digits would solve this problem.
What do we do when multiple digits are stuck together?
In case of complicated syndactilies multiple digits may have got stuck together. The blood supply to the digits in such cases may be abnormal. In such cases we operate only on one side of a digit at a time. Thus it may require staged procedures for complete release in such cases.
How do we know whether the surgery would improve only appearance or function?
After complete examination and investigations like X ray doctor (hand specialist) will be able to tell how much correction is possible.
For simple syndactyly or in minor forms of complex deformity correction may not be necessary if the function is good and they are not restricting growth of other finger.
Toe syndactyly release is mainly cosmetic.
Are there any other tests required?
Diagnosis is usually reached by examination and x ray of hand. Some minor blood tests and chest x ray may be necessary for evaluating fitness of child for surgery and a visit to anaesthesiologist is necessary.
How is the surgery performed?
Surgery involves separation of digits. The skin is adjusted between the digits (with zigzag incision) to cover the raw area that will be opened up after separating the fingers. Sometimes graft may need to be taken of the digital skin is not enough. This is usually taken at the junction of thigh with abdomen.
Are there any risks?
As with all surgery, there is a risk of bleeding infection or necrosis of the smaller skin flaps raised during operations. Sometimes graft loss may happen. Most of these complications are minor and can be corrected with antibiotics and dressing.
The amount of scarring varies from child to child. Normally the scar may not be very noticeable but in a child with tendency of forming bad scars the scars can be ugly.
There is a very small risk of nerve injury or of loss of the blood supply to the digit, but this is very rare with experienced surgeons.
What precautions do we need to take after the surgery?
For initial period there will be a small plaster. It stays on for about a month. After each dressing plaster is re-applied for this period. Then the plaster is removed and normal movements are started.
The child is discharged on 2nd day of surgery and is seen in outpatient on weekly basis. Oral medicines are continued at home.
When do I get back to doctor?
In case the child has fever, the dressing smells, gets wet; child has severe pain not getting relieved by pain killers we advise you to visit us or get in touch with our doctors.