Dr Steve Carter
Syndactyly is a congenital condition in which two or more fingers are fused together. According to Swanson’s Classification this fits into the failure of separation category. Syndactyly can be simple or complex.
- Simple: In simple syndactyly the fingers are joined together by skin and soft tissue.
- Complex: In complex syndactyly the digits are joined by not only skin, but also bone and possibly joints.
Syndactyly can be complete or incomplete.
- Complete: In complete syndactyly the digits are joined all the way to the tips.
- Incomplete: In incomplete syndactyly the digits are joined only part of the way.
Syndactyly correction can vary from simple to very complex.
I have had extensive experience in the surgical management of syndactyly at the Red Cross War Memorial Children’s Hospital in Cape Town over the last 10 years.
My current approach is that the surgery should be delayed until the child is a year of age. This allows sufficient soft tissue for reconstruction. I am using opposing V shaped proximally based flaps to recreate the commissure (webspace).
The webspace is an absolutely unique structure on the human body. It is designed with a particular shape and angle that it is a self cleaning structure (think about it, you never have to clean between your fingers!).
The second point is that there is always a deficiency of skin and in 90% of cases a skin graft is required. If you try and avoid a skin graft your closure will be to tight resulting in a flexion deformity of the finger.
I use skin from either the groin or wrist and the defect that this creates is simply closed in a straight, resulting in a cosmetically acceptable donar defect.
I find the surgical correction of syndactyly to be a very rewarding procedure for the patient, as they are able to regain independent movement of their fingers.