This child's left hand is somewhat unusual. The index, middle, ring, and little fingers are fused together. In addition to syndactyly, the fingers are also shorter than normal, and the entire left hand is significantly smaller than the right hand.
Short fingers and syndactyly are typical hand manifestations of Poland syndrome. The condition may also affect the scapula, chest wall, and the entire upper limb, potentially causing developmental abnormalities in these areas.
Before-and-After Comparison
What is Poland syndrome? Is it related to Poland?
Many parents hear this name for the first time. Poland syndrome is a relatively rare congenital disorder. It was first described in the 19th century by the British physician Alfred Poland, and the condition was named Poland syndrome in recognition of his contribution. It has nothing to do with the country of Poland.
Although Poland syndrome can be relatively rare and complex, for this child, separating the fused fingers is the first priority. The index, middle, ring, and little fingers have been restricted by being fused together for a long time, limiting their range of motion and potentially affecting hand function and development.
Preoperative X-ray
That is why the parents wanted to separate the child's left hand as early as possible. Otherwise, the deformity could affect the appearance of the hand and may also make normal hand use more difficult as the child grows.
For children with Poland syndrome, syndactyly separation can generally be performed at around 6 months of age. Before surgery, the child should weigh at least 6 kg and be in good overall health.
Because several web spaces of this child's left hand were fused together, a skin defect after separation was unavoidable.
The conventional approach would be skin grafting, which requires taking skin from another part of the child's body, such as the armpit or abdomen. This not only creates an additional scar at the donor site, but also carries risks such as skin-graft failure and pigmentation differences.
The parents did not want to create another wound or scar elsewhere on their child's body, so they did not want to use a traditional skin-grafting technique.
Instead, we used artificial dermis to cover the wound. This means there was no need to take skin from another part of the child's body. As the wound heals, the new skin comes from the child's own surrounding tissue, without a significant color difference.
5-Month Postoperative Follow-Up
Five months after surgery, all of the fused fingers on the child's left hand had been separated, and the follow-up examination showed good healing.
The child could open all five fingers and grasp a toy ball well. The child could also use both hands together to twist a toy screw. Overall, the hand posture was good, and the fingers had grown considerably.
At five months after surgery, the scars between the fingers were gradually becoming less noticeable. The parents had been consistently applying scar-reducing medication, and they should continue to wear the nighttime splint.
5-Month Postoperative Follow-Up
At home, parents can also provide toys that require both hands to work together and generate force, which can help encourage the child to use the left hand and further develop its functional abilities.