Timing of surgery

The timing of surgery for congenital syndactyly is contentious. Most hand movements are learned between 6 and 24 months, so there has been an argument for earlier intervention before motor dysfunction commences. Additionally, hand therapy may be easier in a one year old compared to a two year old child. Conversely, if surgery is commenced too early there is a greater risk of revision surgery due to skin contracture and also hypertrophic scarring(1,2). Further, it may be difficult to distinguish vital neurovascular structures in the infantile hand; however, loupe magnification has ameliorated this problem to some extent.

Other 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.

Ref: (1) Eaton CJ, Lister GD (1990). Hand Clin 6:555-575. (2) Skoog T (1965). Acta Chir Scand 130: 537-549.