Friday, August 15, 2014

Scarring after Syndactyly


Syndactyly, or the fusion of digits, is a condition present at birth and is related to the failure of the fingers to separate in utero.  I have previously blogged about this condition, as seen here.  There are different surgical techniques to correct syndactyly and generally good results are obtained, no matter the technique.  

Scarring is one concern with any surgery for syndactyly.  There are several problems with scarring. First, if scar bands form, the finger may contract and motion may be limited.  This can cause a functional problem, most commonly, a limitation in finger straightening.  One way to lower this risk is zig- zag incisions.  Another problem with scarring is what we call creep.  Creep is the slow process of the skin "growing" towards the fingers- causing a loss of the deep webspace.  One way to think of this is that the syndactyly is regrowing.  The literature is not clear on the percentage of children with syndactyly that develop creep after surgery, but it is likely less than 1 in 5 patients.  The 3rd issue regarding scarring after syndactyly surgery is the appearance.  We hope and strive for a complete correction of syndactyly without prominent scars and usually we can accomplish that goal.  However, thick scars and dark skin grafts are a problem that no one likes to see.  We try to avoid skin grafts to avoid the appearance below but sometimes grafts are necessary.  We have found better results with skin grafts taken from the front of the elbow compared to the groin.

Most children with syndactyly reconstruction do wonderfully.  Surgery can create new webspaces between the fingers that look very similar to the other webspaces/ fingers.   It is, therefore, a surgery that we enjoy.  However, the risks of scarring, as noted above are concerning and we work to minimize the risk of those problems.  The surgical techniques and surgeon experience both can help lower the odds of problems with scarring.


Scarring after syndactyly surgery.  Note the prominence in the space between the thumb and index finger.

Scar bands limiting finger extension after syndactyly surgery.  Note also the darkened skin grafts.  
Another view of scarring after syndactyly surgery.  See the lack of finger extension from scars.
The following patient has symbrachydactyly (short, webbed fingers) and has had surgery for the syndactyly.  While he and his family remain pleased, there was creep between the index and ring fingers.


Patient after surgery for symbrachydactyly.  Doing very well but scars are notable.

Limitation noted with creep affecting the space between the index and long fingers after symbrachydactyly surgery.


Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu



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