I commonly treat simple Congenital Hand Differences in my clinical practice. These can occur in 1% of live births. The most common I see in my NHS practice are extra digits (Polydactyly) or fused digits (Syndactyly). Some deformities are unique and cannot be given a single name.

Why do congenital hand differences occur?

Most congenital hand differences occur without a genetic basis and are sporadic. Some cases are inherited and genetic counselling can be arranged for the family.

When do I operate?

In some cases where the extra digit is rudimentary, these can be removed when the child is less than 3 months under local anaesthetic. This is a common procedure I perform in the NHS. If digits are fused I usually wait till 12-24 months to operate. The anaesthetic risk is lower at this age and the structures in the hand are larger and easier to operate on.
 
In some cases if border digits are fused then I operate earlier (around 6-12 months) to prevent deformity.

What is Syndactyly?

Syndactyly means joined or fused fingers, most commonly the 3rd webspace (See picture). It occurs in 1 in 2000 births and is more frequent in boys and can happen in the hands and feet. Simple subtypes of syndactyly are not associated with fused bones and can be incomplete or complete.

How is Syndactyly treated Surgically?

I divide the fingers with a zigzag incision and recreate the webspace with a skin flap taken from the back of the fingers (See pictures). An hourglass flap recreates the webspace between the fingers. There is never enough skin present to cover the new webspace so a skin graft is taken from the elbow or groin. At the end of the procedure the childs hand is wrapped in a bandage and a cast that extends above the elbow.

What is the Post - Operative management for Syndactyly?

I keep the bandage on for a minimum of 2 weeks. It is important that the dressing stays on for this time to protect the skin grafts. The stitches are all absorbable and will drop out eventually. I encourage the use of moisturisers (e.g E45) to prevent wounds drying and aid in scar maturation. Your child will also see a hand therapist in the recovery process.

What complications can you expect after Syndactyly release?

Infection

Poor scarring

Web creep - this is where there is a tendency for the new web to ‘creep’ back

Different colour to skin grafted area

Hair growth at skin grafted area

Nail deformities, particularly in cases where the nails are joined

What is Polydactyly ?

Polydactyly is a condition in which a person is born with extra fingers or toes. I commonly treat children born with extra thumbs or rudimentary digits attached to the little finger. I also treat this condition in the foot.

More complex types of polydactyly will need a general anaesthetic and spare parts are taken from the duplicated digit for reconstruction (See pictures).