It has been far too long since my post on the “Why” of Birth Differences. I apologize and I know at least some of you have been awaiting this post. No excuses but I am now on a new platform and the transition took time. This is Part 2 in which I will review some of the […]
Category: Syndactyly
Syndactyly, Macrodactyly, and Keloid
The treatment of syndactyly is highly successful, no matter the preferred technique. That is the classic technique of Flatt (dorsal commissure flap and zig- zag incisions- ) or graftless techninques or hyalomatrix- all can work. Complications include web creep (maybe not a true complication as it is so commonly seen), wound healing issues, rare infections, […]
Syndactyly as part of a syndrome
Syndactyly is most commonly an isolated finding which we believe is “simply” related to a failure of the cells to regress during development. This failure to regress means that the webspace does not develop ~ the 7th-8th week of gestation. We know that the apical ectodermal ridge is involved and signaling mechanisms including FGF-8. This […]
Congenital Differences- Timing of Intervention in the era of COVID-19
March 28, 2020 We are in an unprecedented time. COVID-19, the coronavirus which began in Wuhan Province in China in late 2019, has impacted our world in many ways. Medical centers in the US and Europe are in a time of crisis as they prepare for or are in the midst of the pandemic. In […]
Syndactyly: The Type Matters.
Syndactyly, simply put, means joined fingers. However, there are a number of different types including:– cutaneous (or simple)- only a skin connection– Complex- with a bony connection– Complicated- with an associated syndrome– Partial vs complete (whether part way or completely to tip of finger).– Complex polysyndactyly. That is, extra bones and bony connections. The partial […]
Recurrent Syndactyly
Syndactyly is the abnormal connection between fingers- typically skin connection but sometimes bony connection (called complex). I have written much about it HERE. There is also information on the internet including some basic information on Wikipedia, NIH, and numerous hospital websites. While syndactyly is one of the most common congenital upper extremity diagnoses, treatment is not perfect and ‘failures’ […]
Macrodactyly, Syndactyly, and Keloid
Macrodactyly is very rare, even at centers such as ours that evaluate and treat many kids with birth anomalies of the upper extremity. Macrodactyly is a difficult condition to research as there is so much variability in presentation- fingers may be dramatically large, moderately large, or only slightly larger than the expected finger size. Treatment […]
Pediatric Hand Study Group 2017
I recently traveled to Philadelphia for the annual meeting of the Pediatric Hand Study Group (PHSG). This group is composed of hand surgeon and therapists who are committed to caring for kids born with hand differences. The meeting was excellent as usual and the hosts included the surgeons from Childrens Hospital of Philadelphia and the […]
Skin Contracture and Z-plasty Correction
The field of hand surgery was developed around the time of World War II combining the fields of orthopedics (care of bones, joints, tendons, muscle), plastic surgery (care of skin, soft tissues, and nerves) and vascular surgery (care of blood vessels). Given the very complex anatomy of the hand, wrist, and forearm, the concept of […]
Meetings
I have been away from this blog for too long. I have been traveling a bit and want to share some information about the meetings I have attended. I hope and expect to get back to regular blogging this week! POSNA Annual Meeting 2016 POSNA is the Pediatric Orthopaedic Society of North America. This organization […]
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 […]
Syndactyly Treatment: What’s Next?
The basic treatment of syndactyly has not changed in many years. The essential surgical care includes the creation of a web space (the ‘commissure’) with a flap and zig- zag incisions to the tips of the fingers to allow separation without straight- line scars (which can contract). There is no doubt that our understanding of […]
Amniotic Constriction Band
Amniotic Constriction Band commonly affects the hand and feet. I have previously posted on the topic on several occasions as can be viewed HERE. I wanted to share a few recent cases to demonstrate the different types of Amniotic Constriction Band. This young child has Amniotic Constriction Band affecting one foot and one hand as depicted […]
Syndactyly Outcomes and Challenges
Most children treated for syndactyly have an excellent outcome with normal finger motion and good maintenance of the reconstructed web space. However, there are times with the ideal outcome does not happen. A less than perfect outcome includes challenges like: prominent scarring, an inability to spread the fingers as widely as […]
Ulnar Deficiency and Syndactyly
Ulnar deficiency (or ulnar longitudinal deficiency) is much less common that radial deficiency, possibly only 1 case of ulnar deficiency per 10 of radial deficiency. And it is much different in the problems that it may cause. The forearm abnormality can include a deficient or absent ulna and flexor muscles BUT, it is much better […]
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 […]
Partial Syndactyly
I have written several times on syndactyly, most recently about an unusual case of thumb- index syndactyly http://congenitalhand.wustl.edu/2013/08/thumb-index-syndactyly.html I have also mentioned (but not discussed in great detail) partial syndactyly. Partial syndactyly means that the fingers are joined together by a skin bridge without bony connection. The skin bridge does NOT travel all the way to the […]
Thumb Index Syndactyly
I have posted a number of times about syndactyly. The two basic posts include:http://congenitalhand.wustl.edu/2011/06/syndactyly.html and http://congenitalhand.wustl.edu/2011/07/frequently-asked-questions-about.html The long and ring finger are most commonly involved in syndactyly whereas the thumb and index finger are uncommonly conjoined. There are several important points to consider regarding thumb and index finger syndactyly: 1) The syndactyly between the thumb and index […]
Toe syndactyly, more thoughts
I have previously posted on toe syndactyly with an example of a surgical case. http://congenitalhand.wustl.edu/search/label/Syndactyly While this was a fascinating case with a very satisfying outcome, it is unusual. Most cases of toe syndactyly involve the lesser toes (toes 2-5) and have little functional or appearance issues. This type of toe syndactyly involving the lesser […]
Toe Syndactyly
Syndactyly, or abnormal joining of the digits, is most commonly considered to involve the hands. This is most likely for two reasons: hands matter more than feet to appearance and hands with syndactyly are more affected functionally than are feet with syndactyly. In most cases, syndactyly of the toes affects the 2nd and 3rd toes, […]
Clinodactyly
I have previously posted on clinodactyly but recently performed several surgeries so I though adding a few more pictures and thoughts might be helpful. There are two types of clinodactyly: isolated and associated with a syndrome. Isolated clinodactyly is common in the general population but is very well tolerated and usually ignored. In fact, many […]
Recurrent Syndactyly
Recurrent Syndactyly This 8 year old male was surgically treated with syndactyly reconstruction utilizing skin grafts 6 years ago (in his hometown). He did well although the skin between the fingers gradually crept distally towards the fingertips. The skin growth limited the spread of the fingers. Creep of web space after syndactyly correction He and […]
Photo of Syndactyly Involving Four Fingers
Syndactyly involving all 4 fingers. Much less common presentation. Likely to have bony involvement.
Photo of the Classic Appearance of Syndactyly
Syndactyly between the long and ring fingers. The most common appearance. Skin involvement only.
Frequently Asked Questions About Syndactyly
Dr. Goldfarb has the answers: 1.When should surgery be performed?There are no firm guidelines on the timing of surgery for syndactyly but some basic principles apply.•Thumb- index finger syndactyly or ring- small finger syndactyly should be corrected early. Many surgeons will consider surgery between 3 and 6 months for these syndactylies.•Index- long finger and long- […]
Syndactyly
What is SYNDACTYLY?Syndactyly is the abnormal connection of 2 fingers. Most commonly, it is a webbing between 2 fingers- the middle and ring fingers. However, it can involve any two fingers or can involve the thumb and pointer finger. It can also involve more than 2 fingers. The webbing can involve the entire 2 fingers […]