Syndactyly
Syndactyly is a condition in which children are born with fused or webbed fingers. About half of children with syndactyly have it in both hands (bilateral). Most of the time, syndactyly affects the fingers. Sometimes it affects the toes, but not as often.
While any two or more fingers can be joined, syndactyly most often occurs between the middle and ring fingers. The fingers may be connected by a flap of skin that looks like webbing. In other cases, the fused digits may look almost like a single finger.
Syndactyly is fairly common. It affects about 1 out of every 2,500 babies. The condition tends to affect boys more often than girls and white children more often than Black or Asian babies.
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.
Testing and Diagnosis of Syndactyly
Syndactyly is the medical term for webbed or conjoined fingers or toes. Syndactyly is the most common malformation of the limbs, affecting about one in every 2,000-3,000 children born each year.
Syndactyly can be classified as:
Simple, where fingers are joined by skin and soft tissue
Complex, where the fingers are joined by bone
Complete, where the whole fingers are fused together to the tips
Incomplete, when fingers are joined only partially
In most children, the affected fingers are connected only by skin; it is rare that the bones are also fused together.
If left untreated, webbed fingers can impair finger growth and hand function and dexterity.
Causes
Syndactyly occurs while a baby is still developing in the womb. During the sixth to eighth week of development, an infant's fingers and toes separate. Syndactyly occurs when the digits fail to fully separate into individual fingers and toes.
This congenital difference is often passed down through families. There is a family history in 10 to 40 percent of cases of syndactyly. In rare cases, syndactyly is associated with other genetic abnormalities and syndromes, including Poland syndrome, Apert syndrome and Carpenter syndrome.
Sometimes, syndactyly can be diagnosed before birth during an ultrasound, though it is usually identified after birth.
In order to determine the best course of treatment for your child, doctors at Children's Hospital of Philadelphia (CHOP) will conduct a thorough physical exam and take a family medical history.
Imaging tests like X-rays may be used to look at the underlying structure of your child's hands and determine whether the bones are fused.
Genetic testing and imaging of other parts of the body may be recommended to identify related genetic syndromes and abnormalities.
Treatment
In cases of simple syndactyly of the middle three digits (i.e. the index, middle and ring fingers), surgery to separate the webbing between fingers or toes should be considered before your child is 2 years old. It is important for your child to have maximum hand function during early childhood when she is rapidly developing fine and gross motor skills.
If your child has simple syndactyly that involves the thumb or small finger (also known as the border fingers of the hand), surgery to separate the conjoined fingers is recommended during the first year of your child's life. The thumb and small finger are of significantly different lengths than their neighboring fingers and early separation will allow all affected fingers to develop more normally and grow equally.
Complex syndactyly should also be repaired by age 1. Early repair can prevent the boney fusion of fingers from causing worsening finger deformities, and allow the digits to grow.
As part of syndactyly surgery, reconstruction of the formerly webbed space between fingers and nail folds, as well as appropriate skin grafting, will be done to optimize the look and function of your child's fingers.
Your child will be able to go home the same day as her syndactyly repair surgery. She will be in a long arm cast for two weeks after surgery.
Follow-up care
Two weeks after surgery, your child will be examined by the hand surgeon, and again six weeks postoperatively. At the two week visit, your child's long arm cast will be removed. Most children will not require splinting or any hand therapy.
Your child will need to return to the hand surgeon for several annual visits throughout early childhood to ensure she is developing appropriate hand function. This is especially important as she learns skills such as writing and playing sports.
Syndactyly is the medical definition for having webbed fingers or toes (digits). It's one of the most common birth defects that affect babies' hands and feet.
Syndactyly in fingers is a form of congenital hand difference.
Your healthcare provider will probably diagnose your baby with syndactyly right after they're born. How it's treated depends on which of your baby's fingers or toes are affected and how they're fused together.
Syndactyly and polydactyly are both birth defects that affect babies' hands and feet.
Syndactyly causes two (or more) of your child's fingers or toes to fuse together — to have webbing that connects them. Polydactyly causes extra fingers or toes to grow on your baby's hand or foot.
Polysyndactyly is the combination of both conditions and causes babies to have both webbed and extra digits.
All of these conditions are usually diagnosed at birth and are treated as soon as it's safe. They usually don't have any lifelong impacts on babies after they're treated.
Management and Treatment of Syndactyly
How is syndactyly treated?
Syndactyly is treated by surgically separating the fused digits. Most babies are treated for syndactyly when they're around a year old.
A surgeon will separate your child's fingers or toes (including any fused bones and other tissue). They'll usually also perform a skin graft to cover the separated digits.
Your child might need to wear a splint or cast on their surgically repaired hand or foot after surgery to support their separated fingers or toes. They might also need some physical therapy to make sure their hand or foot regains its strength and can fully function after surgery.
Your provider or surgeon will tell you which kind of surgery your child will need, and what you'll need to do after their fused digits are separated.
Nonsurgical syndactyly treatment
Some children with mild cases of syndactyly may never need surgery. This is usually only for syndactyly affecting toes. Your provider will tell you whether or not your child needs surgery to separate their digits.
It's rare for kids not to need syndactyly surgery on their fingers because anything that restricts their ability to move can affect the overall function of your child's hand.
How long does it take to recover from syndactyly treatment?
It depends on which type of surgery your child needs. In general, syndactyly surgery has a quick recovery time. Your provider or surgeon will tell you how to care for your baby's hand or foot after their fingers or toes are separated.
How Is Syndactyly Treated
It is treated surgically under a general anaesthetic. Surgery is usually only possible to one side of a finger at a time, as any damage to the blood supply on both sides could result in the loss of the finger. So, if the child has syndactyly of three or more digits next to each other, they will need more than one operation.
Surgery is the only option to separate the digits. The aim of the operation is to improve function (how well the child can use their hand) and sometimes appearance (how the child's hand looks). The surgeon will advise if the benefits to the child are likely to be functional, cosmetic or both.
Occasionally, some children could manage without treatment. Correction of toe syndactyly is usually for cosmetic rather than functional reasons.
Both the parent and the child will need to come to a pre-admission appointment shortly before the operation is scheduled. The purpose of this is to check that the child is well enough for the operation. It is also an opportunity to meet the surgeon again and ask any questions they might have.
The medical team provides written information about the care the child will need after the operation. They might request further X-rays or clinical photographs. At this appointment theywill ask the parent to give permission for the operation by signing a consent form.
On the day of the operation. The nurses will check that the child is well and ask the parent to complete some forms if they have not been filled in previously.
When the operating theatre is ready, parent and child will be collected and taken there by a member of staff. The parent is able to stay with the child until they have had the general anaesthetic, and then will be taken to the child's postoperative ward.
The surgeon will recreate a new web with local flaps of skin from the sides of the digits. This usually involves making a series of zig-zag incisions along the digits, and wrapping the zig-zag pieces of skin to cover up the inside surface of the digits where they were previously joined.
This means that skin from the palm of the hand may end up on the back of the finger and vice versa. If a child's palm is much lighter in colour than the back of the hand, this will be noticeable after the operation.
In most cases, the surgeon will need to use a skin graft to cover up any gaps. The skin for the graft is usually taken from the groin area, so that any scar is hidden in a natural skin crease. This will be a different colour on the hand than the rest of the skin. Occasionally, a skin graft will not be needed.
The operation lasts about three hours. The child will be away from the ward for about one extra hour to give time to prepare for the operation, and to recover from the anaesthetic afterwards. The nurses will tell the parent when the child is in the recovery area and take them there.
The child will have had pain relief in theatre but when this wears off, pain relief will be given in the form of medicines to be swallowed.
Their hand or foot will be covered in a large bandage to protect the skin grafts while they heal. The child will soon find a way to use their bandaged hand or foot in everyday activities. It is best to keep the limb operated on raised above the level of the heart as much as possible to reduce any swelling, which in turn reduces any pain.
It also minimises any oozing under the flaps and skin grafts. Thechild's limb may be raised using pillows or soft toys, or the hand may be placed in a sling when sitting or walking around.
If the child's fingertips or toes are visible, the ward nursing staff will check them on a regular basis for warmth, colour, sensation, movement and blood flow. These checks show that the blood is flowing properly. If the child's digits are not visible, this means that the surgeon was satisfied that the blood was flowing properly at the end of the operation.
Children should be able to go home the day after the operation. They will have been given pain-relief while in hospital, but parents will need to continue giving this at home for at least three days. As well as medicine, distracting the child by playing games, watching TV and reading together can also take thei= mind off the pain.
The clinical nurse specialists will gives parents information about looking after the child's hand or foot at home, particularly keeping the hand dry and raised above the level of the heart.
Syndactyly Surgery - Precautions
When should surgery be performed?
There are no firm guidelines on timing of surgery for syndactyly but some basic principles apply.
Thumb-index finger syndactyly or ring-small finger syndactyly should be corrected early. Many surgeons will consider surgery between 3 and 6 months for these syndactylies.
Index-long finger and long-ring finger syndactyly can be reconstructed in a more elective fashion. Many surgeons choose to operate between 12 and 16 months. the hand is bigger by that age (the hand doubles in size from birth to 2 years of age and nearly doubles once again by maturity), making reconstruction more straightforward. Some families object to waiting this long for surgery, but I believe the benefits of waiting are real.
What happens after surgery?
My preference (and that of many of my peers) is to place a bulky soft dressing on the hand and forearm (and maybe over the elbow). The child returns to clinic at 3-4 weeks for a dressing change and to initiate therapy.
How many surgeries will be necessary?
Usually, only one surgery is required for a syndactyly that affects only 2 fingers. However, about 1 out of every 3 patients will need another surgery - most commonly to deal with web creep.
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