Polydactyly
Polydactyly is a condition in which a baby is born with one or more extra fingers. It is a common condition that often runs in families. The extra fingers are usually small and abnormally developed. Polydactyly is one of the most common congenital (present at birth) hand abnormalities. About one out of every 500 to 1,000 babies are born with the condition, usually with only one hand affected. Black children are more likely to have an extra little finger, while Asian and white children are more likely to have an extra thumb.
Why Choose US
Education Experience
I earned my MD in Surgery from Huazhong University of Science and Technology in Wuhan, China, in 2003. Later, I completed my PhD at Katholieke Universiteit Leuven in Belgium in 2008.
Professional Experience
I am currently an Associate Professor and Chief Physician of Hand Surgery at Wuhan Union Medical College Hospital. I supervise master's students and serve on the editorial boards of several journals, including the Chinese Journal of Experimental Surgery, the Journal of Foot and Ankle Surgery, and the Chinese Journal of Microsurgery.
Expertise
My expertise includes performing syndactyly release using the Pelnac artificial dermal substitute, which eliminates the need for skin grafting. This work was published in the Journal of Plastic, Reconstructive & Aesthetic Surgery in September 2023.
Diagnosis & Treatments of Polydactyly
How is polydactyly diagnosed?
Polydactyly can be seen by ultrasound during pregnancy and by eye at birth. Once your child is born, x-rays will help their doctor see the underlying structure of your baby's fingers and determine a course of treatment.
How is polydactyly treated?
The most common treatment for polydactyly is removing the extra finger. This typically occurs when a child is between 1 and 2 years old. At this age, children are young enough not to miss developmental milestones, such as grasping for objects, but old enough to better tolerate anesthesia and surgery.
The method used to remove an extra finger depends on the location and size of the finger:
Removing an extra little finger can be fairly simple if the extra finger is connected to the rest of the hand by only a small skin bridge. The extra digit is clipped or tied right where it joins the hand, and it will then shrivel and fall off over a period of about two weeks, similar to how the umbilical cord is clipped at birth.
If the extra finger is more fully developed, your child may benefit from a surgery to remove the extra finger. This is typically done when a child is between 1 and 2 years old. This surgery can range from a simple procedure to remove the extra little finger to more complex procedures (for thumbs and central fingers). Sometimes more than one surgery is needed.
After surgery, your child may wear a bulky bandage or cast for a few weeks and have physical or occupational therapy to help with scarring, stiffness, and swelling. They may have follow-up visits to check on how their hand is healing and moving.
What is the long-term outlook for polydactyly?
Most patients treated for polydactyly recover full hand function and improved appearance of their hand.
Your child may need to be followed for several months or years to:
Ensure that their hand is healing well
Check that they are regaining full function of their hand
Determine whether additional surgery would further improve the function or appearance of the hand as your child grows
Your provider will classify the polydactyly your baby is born with depending on where they have extra fingers or toes. The types of polydactyly include:
Preaxial (radial/tibial) polydactyly: An extra thumb or big toe.
Central polydactyly: An extra finger or toe near the middle digits — between the index, middle or ring fingers or any of the toes that aren't the big or pinkie toe.
Postaxial (ulnar/fibular) polydactyly: An extra pinkie finger or toe
Your provider might refer to your baby's polydactyly with different terms.
Providers sometimes refer to extra big toes as tibial polydactyly and extra pinkie toes as fibular polydactyly. Extra thumbs are sometimes called radial polydactyly and extra pinkie fingers are ulnar polydactyly.
No matter which type of polydactyly your child has, your provider will usually diagnose it right after your baby is born.
Your child's doctor will know by sight that your baby's hand has an extra finger.
The extra fingers are usually small and abnormally developed and can be made up of:
Skin and soft tissue
Skin, soft tissue, and bone but no joint
Skin, soft tissue, and bone with a joint
The extra fingers can be located:
On the small finger side - most common
On the thumb side, also called thumb duplication - less common
In the middle of the hand - least common
Management and Treatment of Polydactyly
How is polydactyly treated
Polydactyly is usually treated by removing the extra digit from your child's hand or foot. How it's removed depends on where the extra digit is.
Surgical ligature
If your child has an extra finger on their hand, they might only need what's called a surgical ligature. Your provider will tie a tight string or band around the base of the extra finger that cuts off its blood supply. A week or two later, the extra finger will fall off.
This process won't hurt your baby or endanger blood flow to their other fingers or the rest of their body. Your provider will give you specific instructions to protect your baby's hand during and after this process.
Surgical ligature is usually only used if your baby's extra finger doesn't have any bones or other connective tissues developed in it.
Surgical ligature
If your child has an extra finger on their hand, they might only need what's called a surgical ligature. Your provider will tie a tight string or band around the base of the extra finger that cuts off its blood supply. A week or two later, the extra finger will fall off.
This process won't hurt your baby or endanger blood flow to their other fingers or the rest of their body. Your provider will give you specific instructions to protect your baby's hand during and after this process.
Surgical ligature is usually only used if your baby's extra finger doesn't have any bones or other connective tissues developed in it.
Polydactyly surgery
If your baby's polydactyly is on their feet - or if they're not a good candidate for surgical ligature or in-office excision - they'll need their extra digit surgically removed.
What type of surgery your child will need depends on which type of polydactyly they have and how developed the extra digit is.
Your provider might not recommend surgery to remove an extra digit until your baby is around a year old. They'll explain which type of surgery your child will need and what to expect.
How long does it take to recover from polydactyly treatment
It depends on which type of treatment your child needs. However, both surgical ligature and polydactyly surgery have quick recovery times. Your provider or surgeon will tell you how to care for your baby's hand or foot after their extra digit is removed.
Causes of Polydactyly
It is estimated that up to 1 in 500 newborns have this condition. The cause of polydactyly is usually genetic, and it can be inherited as an autosomal dominant trait. Although most cases are isolated and do not present any associated birth defects, some forms of polydactyly may be related to chromosomal abnormalities such as trisomy 13. To determine the cause and type of polydactyly, physical examination and medical history should be taken along with genetic counseling for families with a family history of the disorder.
The form of polydactyly varies depending on where the additional finger appears on the hand: preaxial (on the thumb side), postaxial (on the small finger side), radial (next to the thumb), ulnar (next to pinkie) or tibial/fibular (near lower leg bones). In addition to a physical examination, imaging studies such as radiographs may help evaluate the structure and position of the additional digit as well as its blood vessel supply. Reconstructive surgery is typically recommended for symptomatic polydactyly to improve the function of adjacent fingers, reduce deformity, and achieve a cosmetically satisfactory result.
Surgery may also prevent long-term complications such as ulnar drift caused by imbalances in muscle forces from asymmetric muscles around duplicated joints. The goal of reconstructive surgery is to preserve sensation while preserving adequate blood flow for the long-term viability of residual digits after removing superfluous digits. For surgeons to achieve successful outcomes with minimal risks involved, proper technique must be used during surgery, such as being mindful of preserving proper nerve function and blood supply while resecting additional fingers appropriately.
In more severe cases, surgery may be necessary to improve function and aesthetics. Reconstructive surgery typically begins with a thorough evaluation, including physical examination, medical history, and imaging such as radiographs to determine the form and position of the additional digit. Surgery is then planned to preserve blood supply and minimize deformity while removing superfluous digits appropriately.
Surgeons may remove some of the soft tissue around the extra digit before resection in order to provide better exposure for surgical removal and reduce potential complications from bleeding vessels located within soft tissue. The surrounding skin can then be closed over the remaining bones either directly or using skin flaps based on surgeon preference. Wound care following surgery should include keeping gauze moistened with wound cleanser until redness has subsided, along with antibiotics if prescribed by your surgeon for infection prophylaxis.
In addition to reconstructive surgery, occupational therapy is suggested for those who experience functional difficulties post-surgery due to imbalanced muscle forces from asymmetric joints or lack of sensation from removed nerves. Occupational therapists (OTs) will assess the strength and mobility of the affected area while evaluating any difficulty with daily activities such as writing, typing, brushing teeth, etc., before developing a personalized therapy plan that is tailored towards improving the patient's quality of life following reconstruction surgery. OTs also help patients adopt strategies for adapting activities so they can safely participate in daily life without fear of re-injury or further complications from an ectopic digit.
Precautions for Polydactyly Surgery
Polydactyly usually is genetic (runs in families). This condition happens to boys and girls equally. Among ethnic groups there are differences in how often the extra finger is on the small finger or thumb side of the hand. Most children with polydactyly are otherwise healthy.
It is best to have the extra toes or fingers surgically removed. If the extra digit is on the hand, the surgery is usually done before a child enters school since he or she will be using the hands more in school. If the extra digit is on the foot, surgery to remove it is done before your child starts to walk.
Call your child's doctor if the extra finger or toe gets twisted and starts to turn blue or black. This sometimes will happen and means it may likely fall off on its own. Your child may experience some pain with this and will need some oral pain medicines.
Tests
Your child's doctor may order an x-ray of the extra digit to help decide how to treat the polydactyly.
Surgery
Usually this procedure is done as an outpatient surgery. The child does not usually spend the night in the hospital.
The surgery staff will call you the day before the procedure to give you instructions about what your child can eat and drink and tell you what time to arrive for surgery.
Your child will have stitches to close the incision. Special glue will be put over the stitches. The stitches will dissolve and do not need to be removed.
If your child has complex polydactyly, more extensive surgery is done (See Pictures 4 and 5). Complex polydactyly has a bone, tendon, and ligament in the extra digit. Your child may need a surgical pin in the hand or foot and may have to wear a cast (see Helping Hand HH-II-2, Cast and Splint Care).
Care After Surgery
Simple Polydactyly
Usually children with simple polydactyly have minimal pain. If they have mild pain they may take Tylenol or Motrin.
The incision can get wet the next day. Your child should avoid soaking it under water and swimming for 2 weeks after surgery.
The glue and stitches fall off within 2 to 4 weeks after surgery.
Your child's doctor and staff will teach you how to take care of the scar (See Helping Hand HH-IV-132, Scar Management).
For this procedure, your doctor will discuss with you the option of coming to the office for a postoperative visit or having one of our nurses call you to check on how your child is doing after surgery.
Complex Polydactyly
Your child may go home with a pin in place to help hold the bones together as they heal.
Your child may have to wear a cast (see Helping Hand HH-II-2, Cast and Splint Care) to protect the site and help the bones heal.
The doctor may prescribe pain medicine for a short period right after your child's surgery.
The pin stays in place or the cast stays on until the doctor sees your child in follow-up clinic.
The doctor may order x-rays of the finger or toe to make sure it is healed before removing the pin or cast.
Fever higher than 101°F with no other causes
Green or yellow drainage from the incision site
The incision pops open
Your child cannot keep down any fluids after surgery
A lot of pain that is not relieved by pain medicines
FAQ
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