Syndactyly

Introduction

Syndactyly is defined as a narrowed or nondifferentiated web space between adjacent fingers. This diagnosis is the most common abnormality of the newborn hand and is typically classified into complete (to fingertip) or incomplete; and simple (isolated soft tissue involvement), complex (with bone or fingernail union), or complicated (more than distal bony fusion) ( Fig. 17.1 ). Syndactyly is often addressed surgically, with the primary goal for treatment being to enhance function and improve cosmesis.

The basic principles of surgical release of syndactyly are established, with literature predominately focusing on different technique descriptions for reconstruction. This chapter does not outline surgical techniques but instead focuses on making surgeons aware of complications that may occur during the preoperative, intraoperative, and postoperative treatment of syndactyly.

History

Syndactyly is a congenital anomaly that occurs in 1/1000 to 1/3000 live births, with bilateral involvement found in approximately half of cases. Simple syndactyly affects most often the third web space, followed by the fourth, second, and first web space. Of note, syndactyly can be an isolated condition or part of a syndrome. The etiology can be due to failure of apoptosis that allows formation of the commissures and separation of the digits versus a persistent apical ectodermal ridge during the fifth and sixth weeks of gestation. Simple syndactyly is likely caused by a failure in apoptosis, whereas complex syndactyly is most likely caused by the apical ectodermal ridge persisting in inappropriate locations. Each patient requires a complete assessment with careful reconstruction planning to reduce risk of complications that may ultimately hinder patient function if not corrected appropriately.

Preoperative Considerations