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Glued fingers or syndactyly

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Syndactyly is one of the most common malformations of the hand. In half of the children, it affects both hands. A third of cases are hereditary.

Two or more fingers are fused. Syndactyly is complete when it affects the entire length of the fingers, incomplete if partial (Figure 21 and 22A).
 

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Figure 21. Complete syndactyly between the middle and ring fingers. Marked is the design of the surgical incision.

 

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Figure 22A. Simple partial syndactyly between the middle and ring fingers.

 

Syndactyly is simple if the fingers are linked only by the skin (Figure 22A). The fingers can also be attached by bone, and this is called complex syndactyly (Figure 23).

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Figure 23. Radiograph showing a complex syndactyly, since the fingertip bone is fused at the end of the third phalanx.

Figure 23B. Radiograph shows a complex syndactyly

Syndactyly requires surgical treatment to provide single function to the fingers. Typically, the separation is performed at 12-18 months. However syndactyly of the fingers of the edges of the hand (little finger and thumb) requires a separation in the first months of life.

The most used technique is based on the separation of the fingers and the “filling” of areas where skin is lacking, with skin graft from the groin or wrist. However, with this technique, the aesthetic results are not excellent and present some long-term complications (scarring impeding full extension of the finger, hyperpigmentation, etc.) (Figure 24).
 

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Figure 24. Outcome of the separation of a syndactyly, several years later, by the usual technique with use of free skin graft. Note the residual scars and hyperpigmentation of the graft.


Dr Soldado uses a technique that does not require skin grafting with excellent cosmetic results and without complications. (FIG 22B and 22C)
 

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Figure 22B. Note the marked incision on the skin and the design of the vascularized skin flap of the back of the hand, designed in order to provide skin at the commissure and to avoid the need for skin grafting and its complications.

 

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Figure 22C. Results of the separation of a syndactyly using the Dr Soldado’s technique.


Complex syndactyly may occur in the context of Apert syndrome, amniotic band syndrome or symbrachydactyly (see other sections).

 

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Figure 25A. Syndactyly of the first commissure. Without the first commissure, the thumb does not have room to perform the pinch.
 

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Figure 25B. Ghani flap design to open the first commissure
 

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Figure 25C. Immediate postoperative image demonstrating the excellent opening of the first commissure. The function of the thumb pinch will be performed perfectly..


Syndactyly of the first commissure

Just as syndactylies of the 4th commissure, syndactylies of the first commisure require early surgical treatment (6 months of age approximately). The reason is that the shorter fingers (thumb and little finger) grow less rapidly than the adjacent ones, causing a deformity in flexion and rotation of the involved fingers, by a phenomenon of "rein". In syndactyly of the first commissure, the technique of choice is flap advancement and rotation of Ghani (Figure 25-C).

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