Syndactyly Multiple Simple

Syndactyly multiple simple

Multiple simple syndactyly is a congenital fusion of over one pair of adjacent fingers or toes with the union formed only out of soft tissue (skin and subcutaneous tissue) and no bone fusion. It is among the more prevalent syndactyly in children.

Syndactyly multiple simple surgery

Multiple simple syndactyly surgery is associated with the separation of more than one fused web space in which the skin and soft tissue are united, and there is no bone fusion. This is intended to bring the fingers back to their normal separation and function, as well as their looks. 

Preparation before Surgery

• Web space clinical evaluation of all the spaces.
• X-rays to rule out bony fusion.
• Preoperative mapping to determine what webs to be released initially (typically gradual in case of numerous fingers)
• Anaesthesia examination and blood tests.
• Parents receive instruction on scars, skin grafts and healing.

Anaesthesia & Positioning

• Carried out with a general anaesthetic agent.
• Child in the supine position.
• Arm secured on a hand table
• Tourniquet to minimize bleeding.

Surgical Marking

• Each of the fused webs is marked with z-plasty or zig-zag incision lines.

Markings ensure:

• Natural-looking web spaces
• Elimination of linear scars.
• Minimum web creep (re-fusion) risk.

Skin Incision & Web Release

• Incision of skin made on the identified zig-zag pattern.
• Close attention to soft tissues separation.
• To both fingers, neurovascular bundles (nerves and vessels) are located and conserved.
• The fingers are all completely detached to the web base.

Web Space Reconstruction

• A new and deep web space is created.
• The web is lined with the rotation and advancement of local skin flaps.
• The re-woven web is formed in line with regular anatomy.

Skin Grafting (If Required)

If there is inadequate skin to cover all the exposed surfaces:

• Skin grafts can be full-thickness or split-thickness.
• Usual Donor Sites: inner aspect of the arm, groin and thighs. 
• The suture of grafts is done with due care to avoid tension.

Hemostasis & Closure

• Blood loss under control.
• Fine absorbable sutures were used.
• Applied dressing in non-adherent layers.
• Fingers are also opened by employing gauze or spacers.

Splint and Immobilization

• Splint or cast is utilized for protection. 
• Poses fingers apart and promotes healing.
• Usually 2-3 weeks of immobilization.

Staged Surgery (If Needed)

Where several webs are to be considered:

• Surgery can be performed in phases (surgical operations).
• Avoids blood supply deficiency of fingers.
• Second stage typically after 3 to 6 months.

Duration of Surgery

• 1-2 hours with one hand (can take more depending on number of webs)

Post-operative Care

• Elevation of the hand
• Narcotics and antibiotics when necessary.
• Dressing changes as advised
• Removal of splints at the time of healing.
• Hand therapy and movement improvement.

Simple multiple syndactyly treatment

Simple multiple syndactyly is characterized by a fusion of more than one pair of toes or fingers, but without any bone fusion. Therapy is aimed at functional restoration, normal development, and enhancement of appearance.

Evaluation & Planning

• Clinical evaluation to evaluate the number of webs involved.
• X-rays to prove no bony fusion.
• Hand movement functional assessment.
• Determine whether the treatment will be a single-stage or staged (significant in cases of multiple fused fingers)

Non-Surgical Management

Observation only if:

• Toes are involved
• None of the issues with functions or footwear.
• Frequent follow-up to assess progress.
• Multiple syndactyly hands are not advised to be treated by non-surgical treatment because it may influence functioning and development.

Surgical Therapy (Definitive Therapy)

• The gold-standard is surgical separation.

Surgical Timing

• Best age: 6 months-2 years 
• Previous surgery when involved with border digits (index- thumb or ring little fingers).
• The process of correcting several webs is usually done in phases.

Surgical Procedure

Zig-zag or Z-plasty cuts 

• Attentive division of soft tissue.
• Saving of nerves and blood vessels.
• Deep web space reconstruction.
• In case of lack of skin locally, skin grafts are applied.

Multiplexed Treatment Staging

• Released only one or two web spaces.
• Lowers the risk of vascular impairment.
• Re-operative surgery in 3-6 months.

Multiple simple syndactyly recovery

Simple surgery in multiple simple syndactyly can generally be smoothed out in case of adequate care and follow-up. Because more than one web space is reconstructed, a recovery may be slightly longer than with single web space syndactyly. 

Postoperative Recovery (First 24 to 72 Hours) 

• Child monitored pain, swelling and circulation to fingers.
• Hand rose to decrease swelling.
• Pain treated using prescribed drugs.
• The surgical site is covered with bulky dressing or cast.

First 2–3 Weeks

• Fingers are immobilized with splint or cast.
• No dressings are generally removed unless recommended.
• Mild erythema and edema are normal.
• The stitches can be removed or fall apart in the course of follow-up.

After Splint Removal (3–4 Weeks)

• Light finger movements stimulated.
• Physiotherapy or hand therapy can be initiated.
• Areas (where skin grafts are used) keep on maturing.
• Hand use (light hand) under supervision.

1–3 Months

• Gaining distance of movement and power.
• The onset of scar softening and flattening occurs.
• Silicone rub or massage can be prescribed on scars.
• The hand is comfortable and used in most of the activities by the children.

3–6 Months

• Approximately normal finger functioning gained.
• Scars continue to fade
• Normal finger growth.
• In case surgery was planned, the following operation can be established at this time.

Long-Term Recovery (6–12 Months)

• End result of cosmetic decisions is evident.
• Low level of functional impairment.
• Uncommon requirement of revision surgery.

Best hospital for multiple syndactyly India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Multiple syndactyly is a frequent, curable inborn disease where more than one pair of fingers or toes is fused together by skin alone. Through early diagnosis, good operative planning and quick intervention, it is possible to attain good functional and cosmetic results. Surgical separation, which is usually staged when there are more than two web spaces, enables normal development of the fingers, enhances hand positioning and reduces the development of complications in the long term. Through proper postoperative management, splinting and hand therapy, majority of children resume their normal hand functions and live a normal active life.

Syndactyly multiple simple India GetWellGo

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Help in choosing from among Best Syndactyly multiple simple surgery Hospitals in India.
• Deserve expertise of cosmetic surgeon with proven results in success. 
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food

FAQ

1. Do you have multiple simple syndactyly?

• Yes. It is also one of the more common syndactyly of children.

2. Should it be treated always?

• The hands normally call out surgical intervention in order to have a proper functioning and growth. In some cases, the use of toes does not require treatment unless the feet have walking or shoeing problems.

3. Will the skin grafts be required all the time?

• Not always. Mild cases can be repaired by the use of local skin flaps. During cases of additional skin coverage, skin grafts are employed.

4. Will the fingers re-fuse following surgery?

• The re-fusion (web creep) is uncommon; hence, with appropriate surgical practice and post-operative management.

5. Will my child be able to use his or her hands normally after treatment?

• Yes. The vast majority of children attain almost normal or normal hand functioning and appearance following treatment.