Complications

Complications of the surgical correction of congenital syndactyly include:

• immediate or early:
  • division of nerve or tendon eg if fused
  • ischaemic digit eg digital artery damaged or digit swells with a tight graft
  • haematoma
  • infection
  • graft loss due to shear, infection or haematoma
• late:
  • deformity of digits or the web:
    • contracture may occur in up to 50% of cases
    • commonly either flexion or lateral deviation
    • more rarely, rotation
    • either due to scarring on the ipsilateral side to the deformity or a growth disturbance secondary to surgery
    • particularly common with contracture secondary to split thickness skin grafts as opposed to full thickness skin grafts
  • poor aesthetic appearance:
    • hair growth on graft in around 10% of all cases
    • nail growth abnormality
    • abnormal pigmentation of, for example, groin skin graft relative to surrounding skin; occurs in approximately 5% of all cases
  • "web creep":
    • advancement of the new web space margin distally down the digits with time
    • around 20% of cases develop
    • may be due to scar contracture or relative growth of soft tissue within the web

Deformity and web creep are the main reasons for re-operation which may be necessary in up to 50% of cases.

Reference

1. Lumenta DB, Kitzinger HB, Beck H, Frey M. Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J Hand Surg Am. 2010 Aug;35(8):1323-9.