1.How many times do I have to have surgery for juxtaposition of fingers?
On the issue of the number of times to operate on a juxtaposed finger, we first need to look at the specific situation of the child, if it can be divided at once and there are no other effects, only one operation is needed. Of course, there are times when syndactyly cannot be divided at once. Why? Because some children have very complicated juxtaposed fingers and if they are separated at once it will affect the blood flow to one or both of the fingers. In this case, we will perform an accurate evaluation to see if we can separate them all at once, and if we really cannot, then we will have to do two surgeries.
In case 11, the child with Poland syndrome had separated all the parallel fingers at once. At the time of surgery, we thought we could separate the fingers at once, because it would be more painful for the child if the fingers were separated multiple times, and we also considered the issue of functional exercise after surgery.
The surgery was very successful, and we basically achieved all of our goals: first, the time was shortened; second, the trauma was reduced; third, there was very little scarring on the back of the hand, almost no obvious scarring, and no skin was taken from other parts of the child’s body. This child just had the surgery in May this year, and the post-operative photo is about three months after the surgery, and the recovery is fine.
In case 12, the child had two finger splitting surgeries, because he had a complex juxtaposition of fingers, with multiple fingers overlapping and unclear boundaries, the middle ring finger was crossed and the little finger was pressed under the middle ring finger. Faced with such a situation, not only parents feel very worried, we doctors also feel more difficult. Of course, there is a solution. After careful surgery, the final result is not bad.
2. Do I need skin implants for the finger separation surgery?
In order to avoid skin grafting, most of these skin defects are covered by designing dorsal palmar flaps or adjacent dorsal skin flaps. In some cases, the skin flap cannot be used to repair the defect, so implantation is still needed to achieve the surgical goal. However, implantation can lead to scarring of the donor area, pigmentation and decreased sensory function of the recipient skin, and there is a certain risk of necrosis of the implant.
To solve these problems, we have designed the method of artificial dermis induced whole skin regeneration, and the benefits of using this method have been briefly introduced above. Some parents may ask, “Can we use this method even if our child has very complicated parallel fingers? Yes, it is possible because the artificial dermal induction method is suitable for all types of syndactyly, and it is more effective for complex syndactyly.
By using the artificial dermal induction method, we not only avoid the process of skin removal and implantation, but also significantly shorten the time of surgical operation, so the time of anesthesia for the child is also reduced. Through long-term follow-up, we found that the finger appearance and sensation of the syndactyly completed by this method is better than that of the skin graft, and it is one of the best options among the known syndactyly surgical approaches.
Case 13 was also a very typical case of Polish syndrome, with a very pronounced syndactyly and short fingers, and a particularly small hand, so we operated on the child at a relatively early age, and I remember that the child was less than half a year old at the time of surgery.
In the traditional way, the child would have needed a flap or an implant to cover the wound after the finger split. After the surgery, the child’s fingers were in good shape and function, and the parents were very satisfied, and we felt very good too.
Case 14 was a cleft hand combined with a merged finger. The child’s hand had poor shape and function, and the child’s mother was very upset. The split finger method was also used to avoid skin removal and implantation, and the skin of the split finger area was normal in appearance, thus obtaining good function and appearance. The child recovered well and the mother was satisfied.
Case 15 is a complicated case of polydactyly with syndactyly, and for such a child, the surgical procedure needs to be chosen very carefully, considering not only the existing condition, but also the future situation after the split finger. Before the surgery, we studied and discussed in great detail the shape and function of the child’s fingers as well as the x-ray findings, and then made a choice to remove the shorter finger and separate the longer middle finger and ring finger.
At the time of finger splitting, we used the artificial dermis free implant technique, and the child’s finger length and joint function were very good, and the parents were very satisfied with the result of the surgery. The parents were satisfied with the result of the surgery. We found that the child’s finger functioned very well when he came for a review some time ago.
As we have already mentioned, the artificial dermis-induced implant-free technique is very effective in the treatment of complex syndactyly, and case 16 is a complete complex syndactyly.
In such a case, there is a problem when we separate it, that is, there is bone exposure at the distal end. It is difficult to solve the problem of bone outgrowth through skin grafting or flaps because the amount of skin at the distal end is relatively small and it is difficult to survive the skin grafting because skin grafting can only be done when the soft tissue is in good condition, but it is difficult to survive the skin grafting on the bone.
Through artificial dermis induction, the surrounding healthy tissues can slowly grow into the wound tissue to achieve a better healing purpose without sacrificing other parts of the body, such as the skin on the stomach, the palm side of the hand or the ulnar side of the hand, so a new surgical technique will have a significant improvement on the outcome of surgical treatment.
3.What is the scar situation after merging finger surgery?
In the early stage, around six months, the color of the scar will be relatively dark. As time goes on, the color of the scar will become lighter and lighter, sometimes even lighter than the normal skin color, which is the process of the overall change of the scar, and parents need to have some understanding of this. Very few children with keloid body may need another surgery to remove the scar, and medication etc. immediately after the surgery can intervene the scar to grow again.
4.What should I do if there are complications after surgery?
There is a situation where the surgery is completed at once, but there is a postoperative complication – web crawl. In fact, web crawl is a condition where the webs of the fingers are normal when the fingers are divided, but after a long time, there is scar formation in the area where the surgery was performed, and they slowly stick together and eventually come back together. If the flippers are not normal after the surgery, then a second surgery will be necessary. This was the case with the child in case 17, who had a very large scar between the middle finger and the ring finger after the finger splitting surgery at an outside hospital, and we performed a second surgery.
However, parents should not worry too much because web crawling does not occur in all babies with merged fingers. Usually, it only occurs in children with scarring, children who develop infections, or some children who are not so perfect in the surgical design.
5. Do I need functional exercises after syndactyly?
Case 18 is a simple complete syndactyly, where the webs of the fingers are all joined together from top to bottom, but there is no bone connection. In this case, we need to pay attention to the time of functional exercise, because if the child does not exercise, the finger will be stiff, so parents should encourage the child to exercise during the healing process. If there is some oozing during the activity, do not be nervous, as it will usually heal quickly with a change of medication. The trauma heals and function is largely restored, which shortens the overall recovery time considerably.
There are several categories of syndactyly, but in fact, each child’s syndactyly will have some more or less differences, so we will have an individualized treatment plan when performing syndactyly splitting, which usually needs to meet three points: first, to try to separate all the fingers that can be separated; second, to try not to cause too much damage to other parts of the body; third, to try to The third is to try to give the child a functional finger. As long as these three points are met, the final result of the treatment is usually more satisfactory.