Congenital deformities are also referred to as birth defects. They are abnormalities that a baby is born with and usually stem from abnormal fetal development. Common congenital deformities include cleft lip, which includes soft tissue abnormalities. Others, such as spina bifida, involve the skeletal structure. Syndactyl is a relatively common congenital deformity. This condition occurs early in fetal development when the fingers and toes are forming. It may be spotted during a prenatal ultrasound but is usually first seen soon after birth.
These procedures are most appropriately performed in a State Licensed, Nationally Accredited Ambulatory Surgery Center (see ‘about Keystone Surgery Center’), these conditions are optimally repaired in infancy or childhood, prior to establishment of patterns of hand function to prevent developmental disabilities.
Since hand surgery is performed primarily to correct physical abnormalities and maintain or restore function, it is considered ‘reconstructive’ in nature and therefore as a ‘covered’ procedure by most health insurance plans. This can be verified by checking your policy or contacting your health insurance carrier.
When considering hand surgery, be sure to select a qualified experienced physician skilled in the diagnosis and management of disorder of the hand. As a board certified plastic surgeon with over 15 years of hand surgery clinical practice experience and member of the American Society of Plastic Surgeons (ASPS), Dr. Robert Kimmel welcomes the opportunity to provide optimal care to patients with disorder of the hand.
This condition usually affects the fingers or a finger and the thumb. The fusion of fingers or toes, referred to as webbing, may be partial or complete. The degree to which two digits are fused can determine the issues that are related to the condition. Syndactyl may involve soft tissue or bone. Interestingly, the main symptom of syndactyl is having a webbed appearance. However, if not corrected, more significant fusion can lead to limited range of motion in the affected hand or foot.
Studies indicate that the fingers and toes form between the sixth and eighth week of fetal development. It is at that time when the digits form separate from one another. Syndactyl occurs when full separation is absent. Why this happens is somewhat of a mystery. That said, there is data that suggests that syndactyl may run in families. In up to 40 percent of cases of webbed fingers or toes, doctors find a family history of the same. Sometimes, syndactyl occurs alongside another genetic abnormality, such as Poland syndrome.
Your doctor may suggest syndactyl treatment as is deemed necessary based on the severity of the fusion. Sometimes, particularly when two toes are fused together, no treatment is needed to foster optimal function. When two fingers are affected, a doctor is likely to recommend the surgical separation of the digits. Surgical repair for syndactyl involves making a zigzag incision along the webbed tissue and reattaching the flaps of skin in two separate pieces. If there is not enough skin around the fused digits to complete the separation, a skin graft may be made using skin taken from another area of the body.
After syndactyl surgery, the repaired hand may be protected by a long arm cast. The surgical procedure is performed on an outpatient basis, so your child can return home within a few hours of their surgery. The cast may be removed as soon as two weeks after the procedure. Depending on the age at which surgical repair is performed or the number of surgeries needed to fully correct syndactyl, physical therapy may be needed to regain the full range of motion after surgery. It’s difficult to predict the exact needs of each patient after syndactyl surgery until we meet in person to discuss the case. After this visit, however, you can expect to have all of the information you need to have realistic expectations regarding this procedure and its recovery.
Surgical correction for webbed fingers or toes is usually considered during infancy. The reason is that a child’s digits provide a foundation for the optimal development of gross motor skills. The timing of surgery may depend on the severity of the webbing and the fingers that are involved. Still, separation is usually done during the first two years of life.