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J Am Acad Orthop Surg, Vol 12, No 1, January/February 2004, 39-48.
© 2004 the American Academy of Orthopaedic Surgeons
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Surgical Treatment of Congenital Syndactyly of the Hand

Khiem D. Dao, MD, Alexander Y. Shin, MD, Annette Billings, MD, Kerby C. Oberg, MD and Virchel E. Wood, MD

Dr. Dao is an Orthopaedic Hand Surgeon, Westminster, CA. Dr. Shin is Assistant Professor, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN. Dr. Billings is Orthopaedic Resident, Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, CA. Dr. Oberg is Professor of Anatomy, Department of Anatomy, Loma Linda University School of Medicine. Dr. Wood is Chief, Hand Surgery Service, Department of Orthopaedic Surgery, Loma Linda University School of Medicine.

Reprint requests: Dr. Dao, West Valley Orthopaedics and Sports Medicine, Suite 150, 23101 Sherman Place, West Hills, CA 91304.

Syndactyly is a congenital anomaly of the hand that is more common in males, is present bilaterally in 50% of affected patients, and often is associated with other musculoskeletal malformations or systemic syndromes. The goal of syndactyly release is to create a functional hand with the fewest surgical procedures while minimizing complications. For simple syndactyly, surgical reconstruction can begin at approximately 6 months, although many surgeons prefer to wait until the infant is 18 months old. Special situations, such as complex syndactyly and involvement of border digits, may warrant surgical intervention earlier than 6 months. Reconstruction of the web commissure is the most technically challenging part of the operation, followed by separation of the remaining digits. Full-thickness skin grafting is almost always required for soft-tissue coverage. Complex syndactyly and syndactyly associated with other hand anomalies warrant special consideration. After reconstruction, patients should be examined periodically until they have achieved skeletal maturity because late complications such as web creep can occur.






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