Syndactyly | Diagnosis & Treatment

How is syndactyly diagnosed?

Syndactyly may be seen by ultrasound prenatally, and is apparent at birth. Your doctor will use x-rays to assess the underlying structure of your baby’s fingers and determine a course of treatment. If the syndactyly is associated with a genetic syndrome, doctors will evaluate the baby’s entire upper extremity, chest feet and head/face to detect other abnormalities.

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).

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

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

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 occupational or physical therapy to help reduce scarring, stiffness and swelling and improve function.

Follow-up visits will 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.

What is the long-term outlook?

The good news is that after surgery, most of our young patients have adequate finger function and an improved appearance of their fingers and hands.

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. Your child may need to wear a cast or splint in some circumstances. If your child's case is severe, they may need additional reconstructive surgery 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