Each case of a baby with polydactyly is different, so the surgical approach varies as well. For more complex cases, surgery requires additional considerations. In this baby's case, both hands have extra fingers, making it more than just a simple removal.
Left Hand Polydactyly
The baby was only 5 months old at the first consultation. He is from Xiangyang, Hubei, not far from Wuhan. Both of the baby's hands have extra fingers, with a total of 12 fingers.
Although the case is not very complicated, the outer extra fingers are pressed tightly, making the thumb web space quite small. Moreover, the right thumb has some issues, being smaller in appearance and functionally weaker.
Which Finger Should Be Retained?
When deciding which thumb to keep, the surgical approach typically considers four key dimensions, along with the actual condition.
1. Function
The goal is to keep the thumb with the better functional capacity since thumb function is crucial, making this consideration highly important for the baby's long-term abilities.
2. Appearance
Generally, the larger and better-formed thumb is kept for cosmetic reasons. Many parents want their children to look like others, so aesthetics play a significant role.
3. Alignment
The thumb that aligns better with the natural force lines is typically retained. Poor alignment can lead to finger deviation, so the surgery might also involve adjusting the relevant tendons and other structures.
4. Bone Development
The development of the bones in the thumbs is also assessed. If the bone is underdeveloped, that thumb might not be suitable to keep.
These four dimensions are not considered in isolation. Usually, by evaluating these factors together, it becomes clear which thumb should be preserved. However, in this baby's case, the situation is more unique. In addition to removing the extra finger, part of it is retained in a procedure known as "on-top."
Right Hand Polydactyly
"On-top" - Combining the Best Parts
The baby's right thumb is still quite strong, so instead of simply cutting off one of the thumbs, the surgical approach involves combining the function and appearance of both thumbs to create the most beneficial result.
In simple terms, the better-looking thumb and the more functional thumb are "fused" together. This is often better than simply removing one thumb altogether.
By preserving both appearance and function, the parents are happy. Their main concern was whether the baby would be able to crawl after surgery.
However, this isn't a major issue. After the "on-top" procedure, with proper recovery exercises, it generally won't affect the baby's ability to crawl or grasp, especially since babies as young as 6 months can undergo this surgery. For children learning to walk, surgery on their hands or feet will not delay their development.
Pre-surgery X-rays
After the baby turned 6 months, surgery was performed on both hands simultaneously. The surgery was very successful, and both hands now have five fingers, giving the parents peace of mind.
Three months after surgery, the baby had recovered well. Both hands are now very agile in playing with toys, and the parents reported that the baby is doing great recently.
The surgery has essentially freed the baby's hands, removing previous restrictions and allowing the baby to use his hands more confidently.
Follow-up
Parents need to guide their child through post-surgery functional exercises. Just like this baby, frequent hand exercises, such as gripping toys, help improve coordination, leading to greater capabilities in the future, like writing, drawing, and using chopsticks or spoons.
Post-surgery care is a crucial aspect. We hope parents will consistently help their child wear the prescribed braces and do the necessary exercises. This needs to be done daily-don't let inconvenience or the child's discomfort lead to giving up. With persistence, the child's outcome will only get better.