Timing of surgery

If syndactyly operative management is warranted, the timing of the surgery is important to discuss. Typically, syndactyly releases are performed around 12 to 18 months of age; delaying the surgery until the child is older than 18 months reduces the risk of scar contracture and web space creep as the child grows.

However, syndactyly of border digits (small finger and thumb web space) and syndactyly with multiple fusions should prompt earlier release as the smaller digit tethers, the longer digit as the patient grows.

Indications for early surgery, typically between 3 and 6 months, include:

• difference in digital length between fused digits which may predispose to greater deformity with growth
• border digits
• complex syndactyly as more likely to need more than one procedure
• multiple syndactylies:
  • thumb is often released in the first instance
  • further operations on the same hand are minimized by planning releases at each staged procedure that release non-neighbouring digit

Normally where both sides are affected, bilateral syndactyly release is undertaken simultaneously.

Reference

1. Vekris MD, Lykissas MG, Soucacos PN, Korompilias AV, Beris AE. Congenital syndactyly: outcome of surgical treatment in 131 webs. Tech Hand Up Extrem Surg. 2010 Mar;14(1):2-7.
2. Dao KD, Shin AY, Billings A, Oberg KC, Wood VE. Surgical treatment of congenital syndactyly of the hand. J Am Acad Orthop Surg. 2004 Jan-Feb;12(1):39-48