Syndactyly

Anita Kurniawati, dr.

 INTRODUCTION

• Syndactyly  Greek
• “syn” meaning “together”
• “dactyly“ meaning “digits”
• Embryological failure of finger separation
• Has a large aesthetic and functional
significance for humans born with the
condition.
 EPIDEMIOLOGY (1)
• Syndactyly  most common of all congenital
hand deformities
• Incidence :
• 1 in 2000 live births
• twice as common
• in males
• in Caucasian population
• Bilateral in half of cases
• 10-40% of cases  autosomal dominant
 EPIDEMIOLOGY (2)

• Can be :
• isolated finding
• seen with other anomalies
• acrosyndactyly, lindodactyly, synostosis,
cleft hand, polydactyly
• feature in several syndromes including
• Apert, Poland’s, Pfeiffer, Jackson-Weiss
and Holt-Oram.
 CLASSIFICATION (1)

• May involve fusion of the soft tissues with

or without bony fusion
• 7th and 8th weeks of gestation  absence of
apoptosis in the interdigital mesenchyme 
failure of differentiation between adjacent
digits
 CLASSIFICATION (2)
• Classified in several ways
• Anatomically  simple or complex and
complete or incomplete
• Simple syndactyly  only soft tissues
• Complex syndactyly  side-to-side bony
fusion.
• Complete syndactyly  adjacent digits are
fused all to the finger tip
• Incomplete syndactyly  refers to only partial
union
 Etiology
• familial history
• factors in-utero that predispose the foetus
to syndactyly
• maternal smoking
• lower nutritional and economic status
• increased meat and egg intake while
pregnant
 TIMING OF SURGERY (1)
• Goal  complete all the releases by
school age
• performed in the neonatal period
• Infancy
• delayed until childhood
• Flatt and Ger  better outcomes with
release after 18 months
 TIMING OF SURGERY (2)
• Syndactyly involving multiple web
spaces usually treated in two stages
• separates the thumb/index finger and
long/ring finger web spaces
• separates the index/long finger and
ring/small finger web spaces  3
months later
Commissure Reconstruction

• Basic syndactyly
release 
reconstruction of
the interdigital
commissure with a
local skin flap
• The most frequently
used methods 
rectangular flap
Commissure Reconstruction

• When the syndactyly is

incomplete and restricted
to the proximal part of the
digit  deepening or
lengthening the existing
web  “Z”-plasty
• Double Z-plasty (butterfly
flap)  mild degrees of
web deepening
Commissure Reconstruction

• four-flap “Z”-
plasty often
used for
deepening
broader webs
such as the
thumb web.
 Separation and Resurfacing of the Digits

• Cronin's technique of a combination of palmar and dorsal

triangular flaps with matched zigzag incisions on both
surfaces of the conjoined digits
Donor Site
Paronychial Fold
• Laterally based
triangular flaps from
the hyponychium of
the conjoined digital
mass are folded
around to form the
lateral nail fold.
 Outcome (1)

• The complexity and technical demands of

release of syndactyly are often underestimated
• detailed three-dimensional planning
• careful technique
• meticulous closure
• The procedure is often time-consuming and
demands patience
 Outcome (2)

• An acceptable outcome with independent digits

that are freely mobile is usually achieved with
separation of simple syndactyly
• In contrast, the outcome after separation of
complex syndactyly is often limited
• severe skin shortage  increase scarring
and diminished mobility.
 Complication (2)

• Early complications :
• vascular compromise
• Infection
• wound dehiscence  tension free wound
closure
• graft loss
 Complication (2)

• Over time, the

commissure may be
drawn in a distal
direction (web
creep) by scar
 Complication (3)
• Joint contractures are a result of contracture
of scars on the palmar surface of the
interphalangeal (IP) joint  revision of the
scar with further skin grafting
• In the fingertip, inadequate soft tissue bulk
and scarring can produce a beaked nail
deformity or an inadequate paronychial fold
• Finally, joint instability may occur after
separation of complex syndactyly as a result
of insufficient collateral ligaments
Thank You