Syndactyly

Syndactyly (from Greek συν- = "together" plus δακτυλος = "finger") is a condition where two or more digits are fused together. It occurs normally in some mammals, such as the siamang, but is an unusual condition in humans.


Classification

Syndactyly can be simple or complex.
* In simple syndactyly, adjacent fingers or toes are joined by soft tissue.
* In complex syndactyly, the bones of adjacent digits are fused. The kangaroo exhibits complex syndactyly.

Syndactyly can be complete or incomplete.

* In complete syndactyly, the skin is joined all the way to the tip of the finger
* In incomplete syndactyly, the skin is only joined part of the distance to the fingertip.

Complicated syndactyly occurs as part of a syndrome (such as Apert's syndrome) and typically involves more digits and with complex syndactyly.

Fenestrated syndactyly means the skin is joined for most of the digit but in a proximal area there is gap in the syndactyly with normal skin. This type of syndactyly is found in amniotic band syndrome.

Simple syndactyly can be full or partial, and is present at birth (congenital). In early human fetal development, webbing (syndactyly) of the toes and fingers is normal. At about 16 weeks of gestation, apoptosis takes place and an enzyme dissolves the tissue between the fingers and toes, and the webbing disappears. In some fetuses, this process does not occur completely between all fingers or toes and some residual webbing remains.


Treatment

Timing

Syndactyly of the border digits (thumb/ index finger or ring/ small fingers) is treated at early age to prevent the larger digit from curving towards the smaller digit with growth. Typically, syndactyly of these digits is treated at 6 months of age. The treatment of syndactyly of the other digits is elective and is more commonly performed when the digits have grown, at 18– 24 months of age.

Techniques

Because the circumference of the conjoined fingers is smaller than the circumference of the 2 separated fingers, there is not enough skin to cover both digits once they are separated at the time of surgery. Therefore, the surgeon must bring new skin into the area at the time of surgery. This is most commonly done with a skin graft (from groin or anterior elbow). Skin can also be utilized from the back of the hand by mobilizing it (called a "graftless" syndactyly correction).

Complications

The most common problem with syndactyly correction is creeping of the skin towards the fingertip over time. This is likely due to tension at the site of the repair between the digits. Additional surgery may be required to correct this. One critique of using skin grafts is that the grafts darken in the years after surgery and become more noticeable. Also, if the skin grafts are harvested from the groin area, the skin may grow hair. Finally, the fingers may deviate after surgery. This is most commonly seen in complex syndactyly (when there has been a bony joining of the fingers).