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Syndactyly is a congenital malformation of the limbs. The child with this syndrome has fused or webbed fingers and toes. It is an abnormal connection between two fingers; it can often involve more than two fingers. It can involve just the skin or the bones. It is the most common syndrome affecting 1 out of every 2000-3000 live births.
Syndactyly is common in boys than in girls. Syndactyly can affect both hands in 50% of cases while also between the ring and middle fingers. However, it can also affect the toes, but the syndactyly on hands is more challenging than for feet and toes. In more than 50 %, it is hereditary.
It is due to incomplete differentiation in which the fingers don’t separate into individual appendages. This separation is usually carried out during the sixth and eighth weeks of embryonic development.
Syndactyly can be found as a single syndrome or associated with other abnormalities, such as polydactyl, ring constrictions, craniofacial syndromes, and cleft hands.
Syndactyly is classified in the following ways based on different conditions and degrees of complexity:
- If the webbing doesn’t extend to the fingertips, then it is incomplete syndactyly.
- If the webbing or joining extends to the fingertips, it is then complete syndactyly.
- If the webbing involves only the soft tissues to join the fingers, then it is referred to as the simple, but if bones or cartilages fuse fingers with the soft tissue, then it is the complex one the fingers are joined only by soft tissue.
- If the fingers are joined by bone or bony cartilage, soft tissue, in a manner other than side-by-side — such as with abnormally shaped, extra or missing bones, complicates syndactyly.
The affected fingers are mostly joined only by skin; in rare cases, the bones are also fused. If the condition is untreated, the fused fingers can impair the growth and function of the fingers.
Usually, syndactyly happens during the development of the hand and arm. The arm forms entirely between 4 and 8 weeks of gestation- about 56 days after the baby being conceived. Although the hands are a lot smaller, they are in their final shape and form. During the last phase of a finger, development nearing 40 days, and after, the fingers are all webbed. Usually, before the 56 days, the skin interconnection disappears, but if the cell signaling is impaired, the skin the webbing stays, and that is what we call “syndactyly.”
Constriction band syndrome is another cause of syndactyly. In this, the hand and fingers usually form, but then there is trauma by a constriction band that leads to scarring and finally to syndactyly. The hands in this kind of syndactyly have short fingers due to the deletion of a fingertip.
Symbrachydactyly is another form of syndactyly. The fingers are short and webbed. Kids with Symbrachydactyly can be different from each other- like some kids have almost normal fingers, some have short and webbed fingers, and some have no fingers at all.
In some cases, syndactyly is an associated defect in a genetic syndrome like Apert syndrome, Poland syndrome.
Syndactyly can also result if the skin or anybody’s structure does not heal properly after an injury, such as a burn.
Syndactyly is visible in utero by ultrasound and is visible at the birth.
A different person with syndactyly tends to experience various symptoms, as webbed toes can be unilateral, impacting only one side of the body, or can be bilateral. The condition can be severe, moderate, or mild.
The condition can be harsh with the digits almost entirely fused, can be moderate with digits partially fused, and can be gentle with only minor webbing between digits.
The limbs can appear symmetric, appearing alike in the same region on both sides of the body. They can be asymmetric, appearing dissimilar in different places on each side of the body. The condition can involve two or multiple digits or bones. The condition can be painful or asymptomatic.
Minor cases do not interfere much with limb movement and function. However, if the limbs are severely webbed or fused, this can leads to disabling.
The plastic surgeon with an orthopedic surgeon will perform surgery to treat syndactyly. They will surgically release the fingers from the webbing.
This surgery is typically performed when the child is 1 or 2 years old. As at this age child can bear the anesthesia risks and surgery as well.
Generally, the surgeon split the skin evenly between the fingers with a zigzag incision. To avoid complications, one side of the finger is separated at a time. Due to this, if the child has multiple joined fingers, more than one surgery is needed.
After the surgery, the child is placed in an above-elbow cast to help immobilize and protect the hand. As the cast is removed, a splint is used to keep the fingers apart.
The doctor will recommend physical therapy to reduce the stiffness, swelling, scarring and improve the function.
After two weeks from the surgery, the child will be examined by the hand and plastic surgeon.
The surgeon will remove the cast after two weeks. You will have multiple follow-ups to ensure the proper functioning of the fingers and hands.