Questions about polydactyly/ polydactyly
Newborn babies are very anxious to find out that they have 2 right thumbs.
Parents do not need to be too anxious. Congenital polydactyly is one of the most common congenital malformations in children and is usually operated on from 3 months to 3 years of age depending on the type and severity of the polydactyly. It is recommended to see a specialist once after the child is full term to clarify the type and severity of the polydactyly and to determine the best timing and treatment plan.
How many types of polydactyly are there and is the surgery complicated?
There are three types according to the location.
Pre-axial polydactyly (thumb-side polydactyly), post-axial polydactyly (pinky-side polydactyly) and intermediate column polydactyly.
According to the polydactyly components, there are also three types of cases.
1, cutaneous soft tissue polydactyly (simpler to treat).
2, cutaneous soft tissue skeletal polydactyly (does not affect the joint and is difficult to treat).
3, cutaneous soft tissue skeletal joint polydactyly (the most difficult to treat, not only removing the polydactyly, but also reconstructing the joints and functions of the fingers.)
In conclusion, the difficulty of surgery for polydactyly, some are simple while others are very complex, and the success of surgery cannot be achieved without rich surgical experience and fine surgical operation.
Cutaneous soft tissue polydactyly
The surgery is relatively simple, but it should not be taken lightly. Do not use thread or hair ligatures at home, otherwise the lighter the polydactyly is not completely removed, there is still a residue of the tip, and in serious cases there may be swelling and necrosis of the finger, infection and sepsis of the wound, and even sepsis, which makes further treatment difficult.
Is there a reason for polydactyly of the thumb? Is it hereditary?
Polydactyly of the thumb is an axial polydactyly, also known as compound thumb deformity, and is the most common type of polydactyly in the yellow race. The exact cause is unknown, and most of them are disseminated, suggesting that it is related to environmental factors and not much to genetic factors. For example, the mother is affected by viral infection, drugs, radiation and other environmental factors during the early 4-8 weeks of pregnancy when the embryonic limb buds are differentiated, resulting in impaired finger differentiation and deformity. The exception is when duplication of the thumb is accompanied by a triple thumb, some of which are autosomal dominant.
Children with polydactyly most commonly have cardiovascular, neurological or urinary malformations, such as congenital heart disease, congenital cerebral dysplasia, etc. This may be manifested by frequent upper respiratory tract infections, blue lips when crying, or stunted growth. A thorough physical examination should be performed in children with suspicion.
Surgery for polydactyly is not simply a matter of removing the extra finger, but also involves blocking the cartilage at the root of the polydactyly to prevent recurrence, reconstructing the joint capsule, ligaments, and muscle stops, and maximizing the appearance of the reconstructed thumb while ensuring the function of the thumb, which is a complex and delicate procedure that requires extensive experience in the key steps. The hospital stay is usually about 4-5 days. The surgery usually leaves a scar, but we use microsurgical suturing techniques for cosmetic suturing to minimize the scar as much as possible, and if the child does not have scarring, the scar will gradually fade to insignificance.
Convergence bunion
This is a complex osteoarticular type of polydactyly. We carefully evaluate the staging before surgery and also evaluate the degree of development of each part, the stability and mobility of the joint, and the degree of deviation of the skeletal axis. After years of accumulation and research, we have adopted an innovative soft tissue reconstruction technique with the thumb long flexor tendon transfer balancing technique as the core for the treatment of “convergent” multiple thumb, which maximizes the reconstruction of an aesthetic and functional thumb. This technique has excellent surgical results and has successfully avoided the need for secondary osteotomies in most children.
Questions about anesthesia for your child’s surgery
The treatment of polydactyly varies depending on the degree of the disease. Simple dermatomal polydactyly can be surgically removed in the first month of life or postponed to the third month of life if anesthesia is a safety concern. Complex polydactyly with articular skeletal connections can be surgically removed between 6 months and 3 years of age. The optimal age for surgery is determined on a case-by-case basis, and an individualized treatment plan is developed.
Although anesthesia is risky, parents should not be overly concerned as general anesthesia does not affect the child as long as there are no accidents; of course, we must prepare the child well for the anesthesia, such as fasting and drinking for 6 hours before surgery, and the child must not have respiratory infections, fever, or other systemic diseases. Through the cooperation of parents, surgeons and anesthesiologists, the risk of anesthesia is minimized. If the child has underlying diseases of other important organs such as heart and lungs, we will conduct a professional assessment of the child’s systemic condition before surgery to determine whether the child can receive surgery and anesthesia.
Questions about syndactyly and toe
What types of syndactyly can be classified? What are the results of treatment?
There are two types of syndactyly: cutaneous syndactyly and bony syndactyly. In cutaneous syndactyly, the combined fingers are skeletally independent and the fingers are usually not deflexed. Skeletal syndactyly, where the combined fingers are connected by bony or cartilaginous tissues and the fingers are often deflected, is very complicated and has many complications.
Are children with syndactyly prone to problems in other parts of the body and what else do we need to check?
Multiple syndactyly or complex bony syndactyly may be a manifestation of certain syndromes in the hand. It is best for the child to have a systematic physical examination to rule out other systemic problems such as cardiovascular, neurological or urinary.
When is the best time to operate for cutaneous syndactyly in infants and children?
Skin syndactyly does not affect the growth and development of the finger, so you can wait until the child is 3 years old to undergo a syndactyly separation + skin grafting surgery, which can effectively reduce the possibility of recurrence of adhesions at the web. In recent years, with the improvement of surgical techniques, the age of surgery has been brought forward to as early as 18 months of age.
Is syndactyly surgery complicated? Do I need a skin graft?
It requires a web flap and a special “Z” shaped flap to prevent scar contracture during growth and development. Most of the merged fingers need to be treated with implants, and the donor area is usually the lower abdomen or thigh, and the inner side of the upper arm.
The procedure requires the protection of the blood vessels and nerves of the separated finger; the removal of the skin graft and the suturing of the graft need to be performed very carefully, and the procedure is very delicate and long. It requires a specialist with considerable experience to perform, because once the first treatment is unsatisfactory, subsequent revision surgery is quite difficult. In the case of multiple juxtaposed fingers, especially the thumb, the marginal finger should be released first and the thumb and index finger should be separated at the age of 6 months to facilitate the development of the basic palmar function of the hand. For example, if the ring finger and the little finger are different in length, the ring finger will be easily deflected and the extension will be limited, so it is better to separate them at the age of 12 months to control and correct the deflection.