Syndactyly

At Children’s Hospital Boston, experts in our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program and our Plastic Surgery Department’s Hand and Microsurgery Reconstructive Program provide comprehensive care for syndactyly—including evaluation, diagnosis, consultation, surgery and follow-up care.

How is syndactyly treated?

Our orthopedic surgeons and plastic surgeons usually treat children with syndactyly by surgically releasing the fingers from their webbing. This procedure is typically performed when the child is between 1 and 2 years old. At this age, the child is old enough to tolerate anesthesia and surgery but is not at risk for missing developmental milestones such as grasping (prehension).

What happens during surgery?

• In general, the skin is split evenly between the two fingers with zig-zag incisions (z-plasty).
• Only one side of a finger is separated at a time in order to avoid complications related to the skin coverage and blood supply of the affected finger. For this reason, if your child has multiple fingers that are joined, more than one surgical procedure will be needed.

Complications after surgery

Complications right after surgery are uncommon and usually minor.But medium- to longer-term complications can include:

• recurrence of the condition (web creep)
• inadequate blood supply to the finger (finger ischemia)
• shortening and hardening of scar tissue (scar contracture)
• skin graft complications
• nail plate deformity

Caring for your child after surgery
After surgery, your child is usually placed in an above-elbow cast for three weeks to help immobilize and protect the hand. Once the cast is removed, a splint that slides in between the fingers and keeps them apart is used for an additional six weeks. During this time, your child’s doctor may recommend occupationalor physicaltherapy to help reduce scarring, stiffness and swelling and improve function.

What is the follow-up treatment plan?
We will want to see your child for follow-up visits to ensure that healing has gone well and function has returned. In some cases, follow-up will continue for years to evaluate whether additional surgery is needed to improve the function or appearance of your child’s hand.

Long-term outlook

Most of our young patients recover full hand function and an improved appearance of their hand. If needed, your child’s team will work with you and your child to learn home exercises that are important to his recovery. He may need to wear a cast or splint in some circumstances. If your child’s case is severe, he may need additional reconstructive surgery(ies) to recover full function and improve the hand’s appearance.

Your child may need to be followed for a number of months or years to:

• ensure that the healing has gone well
• check that function has returned to your child’s hand
• determine whether additional surgery is needed to improve the function or appearance of the hand as your child grows

Coping and support

At Children’s Hospital Boston, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child’s—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:

• getting to Children’s
• accommodations
• navigating the hospital experience
• resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with syndactyly. Will this affect my child long term? Will he be able to play sports and do regular activities? Children’s can connect you with extensive resources to help you and your family through this stressful time, including: 

• patient education: From doctor’s appointments to physical therapy and recovery, our nurses and physical therapists will be on hand to walk you through your child’s treatment and help answer any questions you may have—Why will my child need surgery? How long will his recovery take? How should we manage home exercises and physical therapy? We’ll help you coordinate and continue the care and support your child received while at Children’s.
• parent-to-parent: Want to talk with someone whose child has been treated for syndactyly? We can often put you in touch with other families who’ve been through the same process that you and your child are facing, and who will share their experiences.
• faith-based support: If you’re in need of spiritual support, we’ll connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
• social work: Our  social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties.