Monday, February 8, 2016

Separating joined fingers: A Case Demonstration of a New Strategy

Surgery to separate joined fingers has been largely unchanged for 40 years.  This post is meant to share case pictures and details on this new strategy. Syndactyly, or the abnormal joining of the fingers, is one of the most common birth anomalies of the hands and feet.  In our recent assessment of birth anomalies in NY State, the prevalence of syndactyly was approximately 1.3 in 10,000 live births (polydactyly was clearly the most common anomaly).

The treatment of syndactyly has been successful but with little change over the last 40 years.  I have previously blogged a few times on this topic HERE.  We understand the importance of the webspace (the 'commissure') and avoiding tension on the flaps. Skin grafts are often necessary in syndactyly reconstrution (although there are good graftless techniques- see previous posts).  I recently blogged HERE about a new technique that we have utilized- a skin graft substitute called hyaluronic acid scaffold.  It has been very successful in our hands and we hope to share our early term results soon.

This case demonstrates both the basic principles of syndactyly reconstruction and the use of the hyaluronic acid scaffold instead of skin grafts.  I will blog in the near future with some early postoperative results in another case.

Syndactyly of the middle and ring fingers.

Planned skin incision in syndactyly reconstruction.  Note the primary commissural flap and the zig zag flaps.

Syndactyly reconstruction from palmar approach.
Syndactyly reconstruction after suturing.
Syndactyly appearance from the palm after suturing.
Syndactyly after suturing with areas in need of coverage.

Syndactyly after suturing with areas in need of coverage.

Syndactyly reconstruction after placement of hyaluronic acid scaffolding (white)
Syndactyly reconstruction after placement of hyaluronic acid scaffolding (white)

Syndactyly reconstruction after placement of hyaluronic acid scaffolding (white)

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

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