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Orthopaedic Surgery

Syndactyly (Webbed Fingers)

Syndactyly, derived from the Greek syn meaning together and dactylos meaning digit, is a failure of differentiation in which the fingers fail to separate into individual appendages. The syndactyly can be simple (only soft tissue is conjoined) or complex (bone, nail elements and soft tissues are conjoined).

The normal hand develops during the 5th to 8th week of gestation. Fingers start to develop joined together because of a substance (denominated AERMF) that is present in every one of us. This substance should disappear during the 6th to 8th week of gestation to allow finger separation, when the substance fails to disappear syndactyly occurs. Syndactyly is twice as common in boys as in girls, it occurs in 1 of 2,000 live births and most commonly the long and ring fingers are conjoined. This difference can be part of many genetic syndromes, thus an evaluation by a specialized physician is important to rule out these associations.

Syndactyly can be treated with an operation; depending on each case the hand surgeon will decide the appropriate treatment. The goal of the surgery is to allow independent movement to each finger, in order to obtain a good result each finger must have all the bones and soft tissues complete. Timing of the procedure is decided in an individual basis ranging from 3 months to 1 year, but prompt evaluation by the hand specialist is always crucial.

When surgery is decided to be used, the hand surgeon completes a thorough preoperative planning (Figure 1), a series of incisions (zig-zag pattern) are made to separate the digits and almost always skin graft will be used to cover the site where the separation is performed. Sometimes these skin grafts can get a darker color than the child's own skin because of the cicatrization process. Usually after surgery the hand is immobilized in a splint and dressing changes are only done 2 to 4 weeks later to allow proper skin healing.

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