Syndactyly Release (Webbed or Joined Fingers or Toes)

In cases of simple syndactyly, surgery to separate the webbing between fingers or toes should be considered before your child is 2 years old. It is important for your child to have maximum hand function during early childhood when she is rapidly developing fine and gross motor skills.

Surgery involves raising a skin flap to reform the webspace and additional flaps along the fingers to aid in skin closure with the help of full thickness skin grafts from the groin as needed to ensure timely skin coverage and healing.

Your child’s hand is often put in a bulky bandage or a splint to limit moving while the skin grafts and flaps are healing and these are usually removed at around 7-10 days to check on the healing process.

Scar management is undertaken for some months after the surgery to ensure that the scars heal well and are as fine and soft as possible to support on-going growth.

It may be necessary to perform small revisional surgery if the skin or scars do not stretch to match the speed of growth spurts in your child and reviews during your child’s growth may be necessary to manage how their growth interacts with the released fingers.

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Syndactyly can be classified as:

Simple, where fingers are joined by skin and soft tissue
Complex, where the fingers are joined by bone
Complete, where the whole fingers are fused together to the tips
Incomplete, when fingers are joined only partially

In most children, the affected fingers are connected only by skin; it is rare that the bones are also fused together.

If left untreated, webbed fingers can impair finger growth and hand function and dexterity.

Syndactyly occurs while a baby is still developing in the womb. During the sixth to eighth week of development, an infant’s fingers and toes separate. Syndactyly occurs when the digits fail to fully separate into individual fingers and toes.

This congenital difference is often passed down through families. There is a family history in 10 to 40 percent of cases of syndactyly. In rare cases, syndactyly is associated with other genetic differences and syndromes, including Poland syndrome, Apert syndrome and Carpenter syndrome. In cases where there are genetic syndromes that may impact the general health of your child, these are usually best managed by review at a dedicated children’s hospital. Your RPS surgeon will facilitate a review in the relevant Children’s hospital if this is felt necessary following review of your child.

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What else you should know

How will RPS manage my child's post-operative care?

RPS will give you specific advice regarding your child’s individual post-operative recovery. They will advise:

where your child will go after their surgery
what medication your child will be given or prescribed
what bandages and dressings your child will need and when they’ll be removed
when the stitches will dissolve or need to be removed
when your child can get back to normal activity and exercise
when to book follow-up care for my child

How do I care for my child at home?

After returning home from surgery, you should follow the post-operative instructions provided by the RPS team.

Remember, everyone recovers differently, but you can follow these general steps to optimise healing.

Medicine

Always speak with your RPS team to find out when you can recommence giving your child any existing medication and before starting any new medicine they have prescribed.
Always consult the RPS team before taking new medication, even if it’s over-the-counter.
Always follow the instructions provided with the medication.

Activity

When you have stitches, always check with the RPS team before your child returns to their normal activities.
After a skin graft, any exercise that stretches the skin should be avoided for at least three weeks.

Caring for your child’s wound

The wound will have a dressing covering it to help it heal and protect it from outside elements. If your child had a skin graft you may need to change the bandages. The post-operative instructions given to you will outline how to care for your child’s wound.
If your child had stitches, the RPS team will let you know when or if you have to return to have them removed. In most cases, absorbable (dissolving) sutures are used in children so they do not have to have sutures removed.
Wash the area daily with warm, soapy water and pat it dry. Ensure you don’t use any alcohol or hydrogen peroxide which can slow down the healing process.

When should I call for help?

Notify your health care team immediately if your child experiences any of the following symptoms:

nausea, vomiting or diarrhoea
fever/high temperature – 38°C or higher
your child’s stitches become loose or the wound opens
increasing pain that doesn’t improve with medication
increasing warmth, swelling or redness around incision site
pus coming from the incision site
heavy bleeding from incision site
red streaks leading to the incision site
your child can’t pass stools or gas
signs of a blood clot including pain in the calf, back of the knee, groin or thigh, redness or swelling in their leg.

If your child faints or is short of breath call 000 for emergency care.