This is a little boy with syndactyly in both hands. His left hand has the index, middle, ring, and little fingers fused together, and his right hand has the index, middle, and ring fingers fused. The boy's condition is hereditary, as his family has a history of syndactyly. Some family members have undergone surgeries, but the results weren't ideal. This led to the boy's mother finally deciding to treat his condition when he turned six.
Initial Consultation
Considering the actual situation, we performed the separation of the boy's syndactyly in one surgery, without taking skin grafts from his body. Post-surgery, the boy actively cooperated with rehabilitation exercises. He is now in primary school, and his hand functions are overall quite good. His family is very relieved and happy with the results.
Family History and Mother's Hesitation Regarding Surgery
When they first visited, the boy was already six years old. Since he was about to start primary school, his mother was worried that his hand condition would make him feel inferior, which prompted her to seek a solution for his syndactyly.
According to the mother, there is a family history of syndactyly. Boy's great-grandmother, grandfather, uncle, aunt, mother, and cousin all have varying degrees of syndactyly, either in their hands or feet. The cousin's case was similar to his, and although he had surgery locally when he was younger, it resulted in flexion contractures. This history made the mother cautious and thoughtful when it came to deciding on the boy's surgery.
Initial Consultation
The mother had three main concerns
1.Can the syndactyly of both hands be separated in one surgery? She did not want to go through the ordeal of two surgeries, like child's cousin did.
Multiple surgeries mean:①The child has to endure more pain;②The family has to make more trips back and forth;③Parents need to invest more time and energy to care for the child;④Additional medical expenses.
In general, we assess the skin soft tissue condition, blood circulation, and the finger size to determine whether it's possible to separate the fingers in one go. After evaluating the boy's condition, we decided it was feasible to separate both hands in one surgery.
Pre-Surgery X-ray
2.The mother also inquired about the issue of wound coverage after separating the fingers. She wanted to avoid using skin grafts.
The mother's concern was valid. Skin grafting requires harvesting skin from another part of the body, leaving scars, and often leading to pigmentation changes in the donor area. Moreover, since the boy needed a lot of skin to cover the separated areas, using skin grafts might not be the best approach for him.
We chose to use a method of artificial dermis instead of skin grafts. This method does not require harvesting skin from the child's body. Artificial dermis covers the wound, and as the child's skin heals, the artificial dermis gradually degrades and falls off. However, this process requires more time, especially since the child was already six, and his hands were much larger than a baby's. The wounds from separating the fingers were larger and healed more slowly.
After explaining all these aspects to the mother, she chose the non-grafting method to address syndactyly.
Initial Consultation
3.Given the family history, the mother was more thorough in her considerations. She asked about scar prevention, the use of braces, and how to carry out rehabilitation exercises-very important questions.
Post-Surgery Care and Recovery
The family followed our post-surgery instructions for wound care, and after about a month, the boy's wounds had healed. Rehabilitation exercises began.
At first, I was worried that the boy might be reluctant to do the rehabilitation exercises due to pain or discomfort. However, this boy was very brave, and the parents provided him with a lot of encouragement and support.
4 Months After Surgery – Left Hand
4 Months After Surgery – Right Hand
The boy's recovery has been very ideal. Both his scars and the flexibility of his fingers-especially the range of motion in the metacarpophalangeal joints-are nearly at a normal level. He can write, play finger games, and perform daily activities with great dexterity.
Six Months Post-Surgery
We hope he can maintain this excellent condition, and during the next check-up, we believe there will be even further improvement in both function and appearance.