Finger syndactyly is distinguished from polydactyly and is the most common congenital hand deformity. The most common deformity is that the middle and ring fingers are most often joined together. In mild cases, only the webbing of the fingers is slightly long or the two fingers are partially connected; in severe cases, the two fingers are closely connected, even the nails, finger bones and metacarpals are connected together, and there is a common blood vessel, nerve and tendon.
Finger syndactyly can be manifested as follows: 1) the adjacent fingers are joined; 2) it can be accompanied by ipsilateral pectoralis major dysplasia or or absence; 3) it can be accompanied by narrowing rings of the fingers and forearms, calves and other congenital deformities, which can be a hand manifestation of a syndrome.
Syndactyly often occurs bilaterally and symmetrically, with the most common occurring between the middle ring fingers, sometimes three or four fingers can occur in parallel. The degree of juxtaposition varies from a shallower than normal webbing to a complete juxtaposition to the end of the fingers. In some cases, only the skin and subcutaneous tissue are sutured, but in others, the finger bones and nails are also joined. In severe cases, the absence of interphalangeal joints and flexor tendons, as well as various bony dysplasias, can seriously affect the functional activities of the hand. x-rays can clarify the bony deformities.
The principles of surgical treatment for syndactyly are as follows: 1. If the syndactyly is a juxtaposition of two adjacent fingers, it can be completed in one operation. However, if there are three or more fingers in parallel, it is better to operate in stages to avoid necrosis of the middle one due to blood circulation disorder.
2. If the finger bones and joints are normal and the skin and subcutaneous tissues are abundant, these tissues should be fully utilized and a local skin tissue flap should be designed to cover the lateral part of the finger trauma. The suture of the lateral part of the finger should be serrated to prevent postoperative linear scar contracture. A triangular or rectangular flap should be designed to create a wider web. In most cases, the flap tissue is sufficient to cover only the lateral surface of one finger, and the other side must be covered by a skin graft. In the case of severe shortage of skin and subcutaneous tissue, free flap can be applied to repair the trauma on the lateral side of the finger and the web after the split finger incision.
3. It should be noted that the flap suture should not be too tight during the surgery to prevent the occurrence of partial tissue necrosis after the surgery and the formation of scar contracture later, which will hinder the straightening of the finger and its future growth and development.
There are two points worth noting about the age of surgery: 1. It is generally appropriate to perform the surgery after the age of 3 years to preschool age. If the surgery is performed too early, the child will not be able to cooperate easily after the surgery and will not be able to perform functional exercises, and the implant will be prone to contracture, which will affect the results. The postoperative scar often affects the normal development of the finger, and it is not easy to perform the operation accurately because of the slender and short finger. The child should undergo separation surgery after 1.5 years old, and satisfactory results can be obtained after staged surgery.
2. Genetic examination should be performed to clarify whether it is a familial genetic disease. Children with congenital syndactyly should be consulted early and go to a regular hospital to ask a professional plastic surgeon for consultation and treatment to develop a perfect treatment plan according to the condition in order to promote the physical and mental health of the child to the greatest extent.