From the Guidelines
Syndactyly and clinodactyly should be managed by a pediatric plastic surgeon, as they have the appropriate education, training, and experience to provide optimal care for these conditions. The management of these conditions primarily involves surgical correction, with timing and technique determined by the severity and functional impact. For syndactyly (webbed fingers), surgical separation is typically performed between 6-18 months of age, with complex cases requiring multiple procedures 1. The surgery involves careful separation of the digits, skin grafting to cover exposed areas, and reconstruction of the interdigital space.
Some key points to consider in the management of syndactyly and clinodactyly include:
- Surgical correction is indicated for severe deformity or functional limitations, usually performed after age 6 when growth is more complete 1.
- Postoperative care for both conditions includes splinting, elevation, pain management, and physical therapy to maintain range of motion.
- Early intervention is crucial as these conditions can impact fine motor skills development, though purely cosmetic concerns should be balanced against surgical risks.
- Genetic counseling may be appropriate as both conditions can be associated with various syndromes.
- A pediatric plastic surgeon or other pediatric surgical specialist with the appropriate education, training, and experience is best suited to manage these conditions, as part of a multispecialty team (with pediatricians and other pediatric surgical specialists) 1.
It's worth noting that while there is some evidence to support the use of surgical procedures to address contractures and deformities in conditions such as epidermolysis bullosa, the long-term benefits of these procedures may be limited, and patients often refuse further surgical interventions due to the lack of long-term benefit 1. However, for syndactyly and clinodactyly, surgical correction is generally recommended to improve functional outcomes and quality of life.
From the Research
Management of Syndactyly
- Syndactyly is defined as the union of two adjacent digits and is one of the most common congenital deformities 2.
- The severity of the malformation depends on the fusion level, the tissues involved in the union, and whether it is isolated or syndromic 2.
- Surgery is recommended in the great majority of cases, ideally during early childhood, to improve the hand's appearance and function 2.
- Web space reconstruction is done using local flaps, and digital resurfacing can be done with or without skin grafts 2.
- Graftless techniques have shorter operating times and no morbidity associated with skin harvesting, but their cosmetic outcomes seem to be worse than those of traditional grafting techniques 3.
Comparison of Skin Graft and Graftless Techniques
- A study compared skin graft and graftless techniques in the same patient and found that although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep 3.
- The study found that the mean parents' visual analogue scale for graft cosmesis was 7.1 and 6.2 for graftless, and the surgeon's visual analogue scale for graft was 7.9 and 6.2 for graftless 3.
Harvesting Full-Thickness Skin Graft from the Wrist
- Harvesting full-thickness skin graft from the volar wrist in syndactyly release is a simple and effective option for covering defects on the digits, while producing high-quality scars 4.
- The study found that scar assessment using the Observer Scar Assesment Scale, the Vancouver Scar Scale, and the Withey Score showed high scores for scars at both donor and recipient sites 4.
Surgical Treatment and Outcomes of Syndactyly
- A systematic review of the literature found that different techniques are used to release simple and complex congenital syndactyly, but the level of evidence is predominantly poor 5.
- The review found that although recommendations in favour of any particular surgical technique cannot be given based on evidence, a number of conclusions can be drawn out of the existing literature with regards to the design of the incisions for finger separation, use of pulp flaps and grafts 5.