Syndactyly
Dr Bipin Ghanghurde, hand surgeon, Mumbai, +917738729068, Bipinghanghurde@gmail.com Syndactyly is a common hereditary digit malformation where adjacent fingers are webbed due to a failure to separate during limb development. Surgical release is indicated in almost every case except for a mild, incomplete syndactyly without functional impairment. References Braun TL, Trost JG, Pederson WC: Syndactyly Release. SeminPlastSurg 30:162-70, 2016. 2. Cronin TD. Syndactylism: results of zig-zag incision to prevent postoperative contracture. PlastReconstrSurg (1946) 1956;18(6): 460–468. 3. Dao KD, Shin AY, Billings A, Oberg KC, Wood VE: Surgical treatment of congenital syndactyly of the hand. J Am AcadOrthopSurg 12:39-48, 2004. 4. Malik S: Syndactyly: phenotypes, genetics and current classification. Eur J Hum Genet 20:817-24, 2012. 5. Tonkin MA: Failure of differentiation part I: Syndactyly. Hand Clin 25:171-93, 2009. 6. Withey SJ, Kangesu T, Carver N, Sommerlad BC. The open finger technique for the release of syndactyly. J Hand Surg [Br] 2001; 26(1):4–7.
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Syndactyly
- 1. Syndactyly Dr Bipin Ghanghurde MS Orth, European Diploma Hand surgery Consultant Hand, wrist and microsurgeon Bai Jerbai Wadia Hospital for children Kusum superspeciality orthopedic centre,Mumbai 7738729068 bipinghanghurde@gmail.com
- 2. Types Simple- Skin alone Complex- Bony Complicated- Bony, cartilaginous, transverse bone Complete Incomplete
- 3. When to operate? Release surgery 6 months to 2 years •Prevents deformity •Allows bony growth •Incorporates thumb (If involved) in the development process •Psychologically better before 2 years
- 4. Sequence •Border digits 1st and early •Index /middle • middle/ ring 14 yr old boy with neglected syndactyly
- 6. Apert Hand ( Complicated)
- 7. Apert Syndrome ( Complicated)
- 9. Symbrachydactyly (Special type) “Short webbbed digits”
- 10. Techniques for release of simple syndactyly with graft Pediatric hand and upper limb surgery: A Practical guide; Waters PM, Bae DS, 2012
- 12. TIPS for release of simple syndactyly •Z incisions along the finger. •Web should be always formed by a flap. •Avoid skin grafts on the volar side. •Full thickness skin graft is preferred as it causes less contractures •Both sides of a single digit should not be operated.
- 13. Partial simple syndactyly release
- 14. Release of simple syndactyly without graft Pediatric hand and upper limb surgery: A Practical guide; Waters PM, Bae DS, 2012
- 15. Thank you
Editor's Notes
- Simple syndactyly has only skin fusion and complex shows bony fusion
- Apert hand with multiple bony invovement
- Apert syndrome child has multiple craniofacial anomalies which should be treated first.
- Fenestration between the digits proximal to distal fusion characteristics of constriction band syndrome. Jumble of finger tips. Sinus is variable in size usually distal to normal commissure level.
- Short webbed digits. Can be associated with Polands syndrome. Hypoplastic hand. Absent middle phalynx
- Cronin., Flatt, Blauth, Hentz, Upton, Gilbert, Wood, James
- These are various techniques of syndactyly release without skin graft. The web in these cases is formed by dorsal flap which is based on perforator of dorsal metacarpal artery which supplies the dorsal skin. The resultant donor defect is closed in YV fashion. However it can be used only for simple syndactyly with supple skin.