This child has Poland syndrome on the left hand, with a small hand and severe syndactyly. At 11 months old, we performed a syndactyly separation surgery. Now, over a year post-surgery, the mother reports the child's hand is very functional and frequently used.
8-Month Follow-Up Post-Surgery
"Why can you do it in one surgery when others need two or more?"
The family had visited several hospitals and had some understanding of the condition, so their main concern was the number of surgeries and whether skin grafting was needed.
"Why can you do it in one surgery when others require two or more?"they asked.
Preoperative Photos
Poland syndrome often involves multiple webbed spaces, as in this case, where the child had four webbed spaces. The family hoped all syndactyly could be addressed in a single surgery. Through years of experience, we had a technique to separate all webbed spaces at once. This approach requires specific technical considerations, such as ensuring proper blood circulation, sufficient skin coverage, and an effective covering method.
A one-time separation saves the family time, energy, and money. It also shortens the recovery process, allowing for wound healing and early functional training, which gradually strengthens the grip and encourages hand growth and development. Increased activity promotes growth, creating a positive cycle: the more the hand is used, the bigger it grows; the bigger it grows, the more it can be used.
Initial Consultation
The coverage technique post-separation is a parental concern. Post-separation, some areas may lack skin and typically require skin grafting from the child's body. We use artificial dermis for coverage, which stimulates the surrounding skin to grow inward, avoiding necrosis elsewhere and yielding skin that closely resembles natural skin.
Preoperative X-ray
"Will doing the surgery early cause webbing to regrow?"
When the child first came to the clinic, we recommended early surgery to enable them to grasp more, gain strength, and grow faster. However, the parents hesitated, worrying about the possibility of scar migration if the surgery was done too early.
Scar migration is a common complication after syndactyly separation, whether with Poland syndrome or other types of syndactyly. We have some preventive measures for this. First, we monitor closely during recovery. After wound healing, treatments like scar ointments, nighttime splints, and using gauze to prevent scar migration are employed.
Following the surgical plan discussed with the family, we separated the child's webbed fingers, avoiding skin grafting in a single surgery.
Initial Consultation
First Visit With proper post-surgery care, the child confidently grabs toys alongside her older sister.
Post-surgery, dressing changes are crucial. In the early stages, these can be done in the hospital, but later must be done at home. The family was especially diligent: they recorded the dressing process while in the hospital, then followed our guidance and the recorded video to change the dressing at home, consistently updating us on the child's progress.
After the wound healed, the parents didn't slack on care. They applied scar ointment daily, and despite the child removing the splint every night, they continued reapplying it the next evening. They encouraged, helped, and prompted the child to use the left hand for grasping activities.
With the family's attentive care, by the 8-month post-surgery mark, the child was peeling oranges and playing with two-handed toys skillfully, and the hand had grown considerably.
8-Month Follow-Up Post-Surgery
At the 16-month mark, the mother shared a video and informed us that the left hand is recovering well, flexible but still slightly different from the right. However, they believe that by continuously encouraging the child to use and strengthen the left hand, the functional and developmental differences between the hands will gradually diminish.
16-Month Follow-Up Post-Surgery
We hope that at the next check-up, the child's hand will have grown larger and have even better function!