Syndactyly: Webbing of the Fingers & Toes

What is syndactyly?

Syndactyly is a medical term that describes webbed fingers or toes. The webbing of digits means that the digits are fused. 

In some cases, the fusion could be between bone, blood vessels, muscles, and nerves although this occurs rarely.

Syndactyly is congenital, meaning it is present at birth. According to Boston’s Children Hospital, syndactyl occurs in 1 out of 2500 babies. It affects males more and it is also commoner in the Caucasian tribe. The commonly webbed fingers are the ring finger and the middle finger.

Syndactyly can affect the functioning of the hand or foot. Minimal webbing may not require surgery but a webbing that is severe enough to affect foot or hand functioning will require surgery.

A prenatal ultrasound scan can be used to detect webbed digits although it may not be so accurate.

What causes webbed fingers and toes?

About 10 to 40 percent of webbed digits have a hereditary undertone. Webbed digits can occur as a component of Poland syndrome, Apert syndrome, and Holt-Oram syndrome. In some cases, the cause may not be known.

Surgical repair of webbed fingers and toes

The exact timing of surgery is unknown as there are different schools of thought however, the prevalent notion is that the surgery should be done when the child is a few months old.

A surgeon will schedule the time for the surgery. The surgery is necessary before the child misses developmental milestones that involve the fingers such as object grasping.

The surgery done is called a Z-plasty, it is done by making some zigzag incisions to separate the fingers or toes that are fused, and is ideally done with the child sedated.

The zigzag incisions split the excess webbing between the child’s digits. The exposed skin is grafted by using healthy skin pieces from another child’s body to cover the separated area.

The digit separation is essential to allow the digits to move independently and it aims to restore the child’s hand functionality.

If more than one area of the hand is affected, multiple surgeries may be required to lessen risk.

After surgery

Following surgery, the child’s hand or foot will be put in a cast for about 3 weeks and the cast will help to immobilize the hand or foot. The cast should be kept clean, cool, and dry and should be covered when bathing the child.

Following removal of the cast, a splint should be worn for several weeks to protect the area that was repaired and further enhance recovery.

To increase the chances of recovering the full functionality of the fingers or toes, the surgeon may recommend physical or occupational therapy. Follow-up visits would be needed to monitor recovery.

Risks associated with surgery for syndactyly

Complications may occur following surgery for repair of webbed digits and they range from mild to moderate effects.

The possible complications include:

  • Web creep: refers to extra skin growth and this prompts additional repair.
  • Failure of skin graft used for repair
  • Scar tissue hardening
  • Infection
  • Ischemia: refers to the shortage of blood supply to the fingers or toes
  • Change of appearance of the affected digit

Ensure to see a doctor if you notice any of the symptoms above.

Outlook for syndactyly surgery

Most children experience normal finger or toe functioning following surgery although there may be some abnormalities since the digits are now moving independently.

If complications ensue, additional surgeries at a later date may be indicated to help achieve full functionality of fingers or toes. The growth of the hand and foot after surgery will be normal although some children will require extra surgery on reaching adolescence after full maturity of the hands and feet has been attained.