Diagnosis
As a rule, syndactyly is a so-called gaze diagnosis, which immediately catches the eye when viewed alone. In order to confirm the diagnosis, an X-ray of the hand should always be taken. On the basis of the X-ray image, a bony syndactyly can be distinguished from a soft tissue syndactyly.
Therapy
A syndication of the hand should be operationally separated around a good function of the hand taking into account the existing risks. However, the surgical indication should include the shape and localization (affected fingers), so that a general statement cannot be made. With fingers of equal length, this operation usually follows in the second year of life, sometimes later.
One waits for this time frame, since the surgical risks decrease if the fingers are large enough. Only in the case of fingers of unequal length is the operation performed in the first year of life, since permanent damage to growth is to be expected at a later time of the operation. In most cases, the changes also affect the nerves and vessels (arteries and veins).
This must be taken into account during the separation operation and nerves, as well as vessels, must be carefully separated. The difficulty of the operation is to cover the separated fingers with skin again. Overall, there is too little skin available.
It is important that the skin ends are sutured together without tension, so that no excessive scars can form. Areas that cannot be covered with skin must be covered by skin grafts from other bodies. Due to the risk of complications, especially circulatory problems, only two fingers can be separated during one operation. If several fingers are joined together (multiple syndactyly), the operations must be performed one after the other, at six-month intervals. Due to the complex nature of the operation, the operation time is usually more than 3 hours.
Risks of the operation
If the blood vessel supply cannot be separated completely, this can lead to wound healing disorders for post-operative care. In rare cases, blood circulation can be so poor that the finger dies or has to be amputated before it becomes inflamed.If the nerves are only simply applied, a permanent numbness of the separated finger insides can occur after the separation. If excessive scars are formed after the operation, there is an increasing inability to stretch the operated fingers completely (bending contracture).
In addition, the webbing between the fingers can grow back towards the fingertips as the fingers grow. This again limits the function of the fingers. Another operation (recurrent surgery) must follow.
