Some time ago, I saw a little baby with syndactyly at the age of about 6 months in my outpatient clinic. The parents brought their baby from Jilin to Wuhan because they wanted to do the finger splitting surgery, but they did not want to take the skin from their baby for skin grafting, so they came to the clinic immediately after they learned that we could use the skin graft-free technology. In fact, there are often mothers and fathers in the clinic asking whether their babies need implants for finger splitting. I. What is a juxtaposition of fingers (toes)? Syndactyly refers to the fusion of adjacent fingers (toes) into one, which is a kind of congenital malformation. They are classified as simple or complex depending on the tissue involved. Simple syndactyly is divided into complete and incomplete syndactyly according to the extent of the skin connection of the webs of the fingers. Clinically, simple syndactyly is marked by adhesions to the skin or soft tissues only, while complex syndactyly is marked by bony fusion. What about the lack of skin during finger separation? In order to avoid skin grafting, most of these skin defects are covered by designing dorsal palmar flaps or adjacent dorsal finger flaps. However, for some complex complete syndactyly, there are still some defects that cannot be repaired by flaps, so skin implants are still needed to achieve the surgical purpose. Third, what are the principles to be followed in juxtaposition surgery? The principles of finger merging surgery are very simple, there are only 2 points: 1. When is the best time to perform the surgery? No matter which type of syndactyly the baby has, as long as the baby has no other diseases and the weight is up to the standard, the surgery can be performed when the baby is about 6 months old. The advantages and disadvantages of implant and implant-free technology The advantages and disadvantages of implant and implant-free technology can be compared mainly around the appearance, sensation, survival rate, healing time and the difficulty of postoperative care. Skin grafting 1. Appearance The skin needed for skin grafting is usually on the baby’s belly, so after the skin is removed, a scar will be left on the baby’s belly that is relatively obvious. This scar, which is fine for male babies, is not good for female babies who love beauty when they grow up. After the skin grafting, the skin area on the baby’s hand will also have obvious color difference and different texture after healing, and some babies will even grow hair on the skin grafting area. 2. Sensation Because the skin transplants need to re-establish innervation, the sensation of the skin after transplantation is different from that of the original skin. 3.Survival rate The survival rate of the transplanted skin is not 100%, and there is a possibility of necrosis. Skin graft-free technology 1.Appearance Skin graft-free technology is to use artificial dermal material on the wound site to make the surrounding normal skin grow slowly to the middle, so that the newly grown skin is more similar to the original skin. Since the skin does not have to be removed from the baby, there is also no scarring on the non-surgical site. 2.Feeling Since the new skin is regrown, the feeling is not much different from before. 3.Survival rate The implant-free skin does not require skin removal and implantation, so it does not have the problem of survival rate. 4.Healing time Since the artificial dermis is normal skin growing slowly to the middle, the healing time is a little longer, about 6-8 weeks. 5.The difficulty of post-operative care The care requirement of implant-free technology is a little higher than that of skin implant. Since the artificial dermal material is attached to the wound, parents should keep an eye on the baby until the skin is completely healed, and do not let the affected hand touch the water or touch around to prevent infection. In conclusion, for small babies with parallel fingers (toes), it depends on the actual situation whether skin implants are needed in the process of finger (toe) splitting.