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Houston Cranio Facial

Polydactyly and Syndactyly

There are many different types of congenital hand anomalies that can be present at birth. The two most common are polydactyly and syndactyly, which can occur in the hands and the feet. If your child was born with multiple fingers or toes, or fused fingers or toes, Dr. Eric Payne, our experienced plastic surgeon, can help correct this condition in children as young as six months.

What Are Polydactyly and Syndactyly?

Polydactyly is defined as having multiple digits greater than the normal five digits that are present on each hand and foot. Syndactyly is defined as fusion of one or more digits of the hands and feet. Occasionally, these disorders can be inherited from the parents and passed onto future children. Most of the time polydactyly and syndactyly are sporadic and spontaneous occurrences.

Polydactyly of the hands and feet can occur as extra digits either on the thumb or large toe side, also known as preaxial, or on the small finger/toe side, known as postaxial. These extra digits can occur with or without bone connections.

Treatment Options for Polydactyly

With skin-only connections, the digits can be easily removed under local anesthetic in the office before the age of 3 months. Some physicians have tried using suture ligation of the extra digit; however, this is not always successful. There are two problems with suture ligation, or tying off the nub, in the nursery. First, it takes more than two weeks for the finger to fall off and during that time it becomes a black mummified digit that most parents find unsightly. Second, occasionally there is a small bump that is left behind which can be tender and causes discomfort. If polydactyly occurs with a bony connection to the other fingers, this will require cutting through the bone. This is technically more challenging and will typically need to be done in the operating room under general anesthesia after six months old.

Treatment Options for Syndactyly

Syndactyly of the hands and feet can occur with varying degrees of fusion of the digits. The most common type of fusion is with skin only between either the toes or the fingers. Rarely does syndactyly occur involving the thumb. Fusion of the bone between the digits can occur and is more difficult to separate because it requires cutting of the bone to separate the digits. We believe that syndactyly of the toes and feet should be treated in the same fashion that syndactyly of the hands is treated.

Treatment of syndactyly involves creating skin flaps to deepen the web space between the digits and applying skin grafts to the open exposed areas between the digits. Typically, syndactyly of the digits, if occurring in multiple fingers or toes, may need to be done in more than one operation. The recovery time after syndactyly release usually takes two-three weeks for the wounds and skin grafts to heal. We have found that treating the child with syndactyly of the feet before 9 months of age can achieve the best results, because the child is not yet begun to walk. Typically, we use a hard cast from the foot to the thigh which is kept in place for two weeks. We use the same type of hard cast from the hand to the upper arm when treating syndactyly of the hands. Syndactyly of the hands can be treated after 6 months of age and older.

Learn more about polydactyly and syndactyly by scheduling a consultation with Dr. Payne. Contact us today for more information.