eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Syndactyly: Multimedia

Author: E Gene Deune, MD, Associate Professor of Orthopedic Surgery, Associate Professor of Plastic Surgery, Co-Director, Division of Hand Surgery, Director, Hand Surgery Section and Pediatric Hand Surgery, Johns Hopkins University School of Medicine
Contributor Information and Disclosures

Updated: Feb 5, 2009

Multimedia

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Media file 1: (Images 1 and 2) Dorsal view of a hand demonstrating simple incomplete syndactyly between the left long finger and ring finger. Note the incidental café-au-lait spot.

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(Images 1 and 2) Dorsal view of a hand demonstrating simple incomplete syndactyly between the left long finger and ring finger. Note the incidental café-au-lait spot.

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Media file 2: (Images 1 and 2) Palmar view of the same hand with syndactyly. The level of the syndactyly, just proximal to the proximal interphalangeal (PIP) joint, can be clearly seen on the palmar view.

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(Images 1 and 2) Palmar view of the same hand with syndactyly. The level of the syndactyly, just proximal to the proximal interphalangeal (PIP) joint, can be clearly seen on the palmar view.

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Media file 3: (Images 3 and 4) Dorsal view of the hand of a 1-year-old child with a complete simple syndactyly. Note that both the long finger and the ring finger have distinct nail plates with a trough separating them.

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(Images 3 and 4) Dorsal view of the hand of a 1-year-old child with a complete simple syndactyly. Note that both the long finger and the ring finger have distinct nail plates with a trough separating them.

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Media file 4: (Images 3 and 4) Palmar view of the hand of a 1-year-old child with a complete simple syndactyly.

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(Images 3 and 4) Palmar view of the hand of a 1-year-old child with a complete simple syndactyly.

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Media file 5: (Images 5-7) Dorsal view of hand of a 6-month-old patient with type I Apert syndrome. Note that the thumb is separate.

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(Images 5-7) Dorsal view of hand of a 6-month-old patient with type I Apert syndrome. Note that the thumb is separate.

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Media file 6: (Images 5-7) Radial view of hand of a 6-month-old patient with type I Apert syndrome. The index fingernail is separate, and the syndactyly is complete. The small fingernail is also separate from the rest of the hand. A simple syndactyly between the small finger and the rest of the hand is present. Note that the broad thumb and the abnormal curvature of the thumb is due to the presence of a delta phalanx seen in the x-ray below.

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(Images 5-7) Radial view of hand of a 6-month-old patient with type I Apert syndrome. The index fingernail is separate, and the syndactyly is complete. The small fingernail is also separate from the rest of the hand. A simple syndactyly between the small finger and the rest of the hand is present. Note that the broad thumb and the abnormal curvature of the thumb is due to the presence of a delta phalanx seen in the x-ray below.

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Media file 7: (Images 5-7) Radiograph of hand of the 6-month-old patient with type I Apert syndrome demonstrates the distinctive characteristics of Apert syndrome. In the small finger, the distal interphalangeal (DIP) is formed. Although a rudimentary proximal interphalangeal (PIP) joint is present, clinically this joint is stiff. In the ring, long, and index fingers, no PIP joint is present, and symphalangism is present between the middle and the proximal phalanges. The distal phalanges of the ring and long finger are fused. In the thumb, the proximal phalanx is shaped abnormally and is referred to as the delta phalanx. Synostosis of the ring and the small finger metacarpals is present.

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(Images 5-7) Radiograph of hand of the 6-month-old patient with type I Apert syndrome demonstrates the distinctive characteristics of Apert syndrome. In the small finger, the distal interphalangeal (DIP) is formed. Although a rudimentary proximal interphalangeal (PIP) joint is present, clinically this joint is stiff. In the ring, long, and index fingers, no PIP joint is present, and symphalangism is present between the middle and the proximal phalanges. The distal phalanges of the ring and long finger are fused. In the thumb, the proximal phalanx is shaped abnormally and is referred to as the delta phalanx. Synostosis of the ring and the small finger metacarpals is present.

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Media file 8: Apert type II hand. Note the complete syndactyly between the ring and the small fingers. The patient's hand was complicated by a chronic paronychia and skin maceration preoperatively.

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Apert type II hand. Note the complete syndactyly between the ring and the small fingers. The patient's hand was complicated by a chronic paronychia and skin maceration preoperatively.

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Media file 9: Apert syndrome (type III), dorsal view.

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Apert syndrome (type III), dorsal view.

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Media file 10: Apert syndrome (type III), volar view.

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Apert syndrome (type III), volar view.

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Media file 11: Radiograph of the left hand of a patient with Apert syndrome (type III). Note the complicated syndactyly with osseous union in the distal phalanges of all the fingers. Symphalangism is present between the proximal and middle phalanges, without the formation of a proximal interphalangeal (PIP) joint in the ring, long, and index fingers.

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Radiograph of the left hand of a patient with Apert syndrome (type III). Note the complicated syndactyly with osseous union in the distal phalanges of all the fingers. Symphalangism is present between the proximal and middle phalanges, without the formation of a proximal interphalangeal (PIP) joint in the ring, long, and index fingers.

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Media file 12: (Images 12 and 13) Poland Syndrome: Dorsal view of a left hand in a patient with Poland Syndrome with brachydactyly (short fingers) and adactyly (missing fingers) with associated simple incomplete syndactyly between the ring and the small finger

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(Images 12 and 13) Poland Syndrome: Dorsal view of a left hand in a patient with Poland Syndrome with brachydactyly (short fingers) and adactyly (missing fingers) with associated simple incomplete syndactyly between the ring and the small finger

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Media file 13: (Images 12 and 13) Volar view of the preceding hand in a patient affected with Poland syndrome.

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(Images 12 and 13) Volar view of the preceding hand in a patient affected with Poland syndrome.

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Media file 14: (Images 14 and 15) Right hand of a patient with Poland syndrome. Note the incomplete syndactyly between the hypoplastic right index and long fingers.

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(Images 14 and 15) Right hand of a patient with Poland syndrome. Note the incomplete syndactyly between the hypoplastic right index and long fingers.

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Media file 15: (Images 14 and 15) Volar view of the index and long finger in incomplete syndactyly in a patient with Poland syndrome.

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(Images 14 and 15) Volar view of the index and long finger in incomplete syndactyly in a patient with Poland syndrome.

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Media file 16: (Images 16-23) Dorsal view of the right hand of a 1.5-year-old patient with constriction band syndrome. The fingers can still be identified individually. Note the presence of a fistula tract between the affected fingers, particularly between the long finger and ring finger.

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(Images 16-23) Dorsal view of the right hand of a 1.5-year-old patient with constriction band syndrome. The fingers can still be identified individually. Note the presence of a fistula tract between the affected fingers, particularly between the long finger and ring finger.

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Media file 17: (Images 16-23) Palmar view of the right hand of a 1.5-year-old patient with constriction band syndrome. The fingers can still be identified individually. Note the presence of a fistula tract between the affected fingers, particularly between the long finger and ring finger.

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(Images 16-23) Palmar view of the right hand of a 1.5-year-old patient with constriction band syndrome. The fingers can still be identified individually. Note the presence of a fistula tract between the affected fingers, particularly between the long finger and ring finger.

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Media file 18: (Images 16-23) Right hand of a 1.5-year-old patient with constriction band syndrome. Radiograph demonstrates that the level of the amputation occurred at the proximal interphalangeal (PIP) joints.

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(Images 16-23) Right hand of a 1.5-year-old patient with constriction band syndrome. Radiograph demonstrates that the level of the amputation occurred at the proximal interphalangeal (PIP) joints.

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Media file 19: (Images 16-23) Dorsal view of left hand of a 1.5-year-old patient with constriction band syndrome. The left hand is more severely involved than the right, with all of the fingers being nearly indistinguishable from one another. Note the presence of pits between the fingers where normal webs would be. The most prominent one is between the ring and the small fingers. They often represent fistulas between the dorsal and the volar surface of the hand and are often the only thing remaining of the previous normal web space.

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(Images 16-23) Dorsal view of left hand of a 1.5-year-old patient with constriction band syndrome. The left hand is more severely involved than the right, with all of the fingers being nearly indistinguishable from one another. Note the presence of pits between the fingers where normal webs would be. The most prominent one is between the ring and the small fingers. They often represent fistulas between the dorsal and the volar surface of the hand and are often the only thing remaining of the previous normal web space.

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Media file 20: (Images 16-23) Volar view of left hand of a 1.5-year-old patient with constriction band syndrome. The left hand is more severely involved than the right, with all of the fingers being nearly indistinguishable from one another. Note the presence of a prominet fistula between the small finger and ring finger.

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(Images 16-23) Volar view of left hand of a 1.5-year-old patient with constriction band syndrome. The left hand is more severely involved than the right, with all of the fingers being nearly indistinguishable from one another. Note the presence of a prominet fistula between the small finger and ring finger.

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Media file 21: (Images 16-23) Radiograph of left hand of a 1.5-year-old patient with constriction band syndrome. The level of amputation is through the midportion of the proximal phalanges of the involved fingers.

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(Images 16-23) Radiograph of left hand of a 1.5-year-old patient with constriction band syndrome. The level of amputation is through the midportion of the proximal phalanges of the involved fingers.

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Media file 22: (Images 16-23) Image of the left hand of a 1.5-year-old patient with constriction band syndrome after a second reconstructive procedure following release of the second and fourth web spaces. The syndactyly partially recurred because of a skin-graft loss. During the second-stage operation to separate the long finger and ring finger, the recurrence in the second and fourth web spaces were re-revised. Thus, sutures are present on both sides of the ring finger and long finger.

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(Images 16-23) Image of the left hand of a 1.5-year-old patient with constriction band syndrome after a second reconstructive procedure following release of the second and fourth web spaces. The syndactyly partially recurred because of a skin-graft loss. During the second-stage operation to separate the long finger and ring finger, the recurrence in the second and fourth web spaces were re-revised. Thus, sutures are present on both sides of the ring finger and long finger.

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Media file 23: (Images 16-23) Palmar view of the right hand of a 1.5-year-old patient with constriction band syndrome after a previously staged syndactyly release. No skin graft was needed for the release between the long and ring fingers. The patient also underwent revision of the web space between the index and long fingers.

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(Images 16-23) Palmar view of the right hand of a 1.5-year-old patient with constriction band syndrome after a previously staged syndactyly release. No skin graft was needed for the release between the long and ring fingers. The patient also underwent revision of the web space between the index and long fingers.

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Media file 24: (Images 24 and 25) Complete simple syndactyly of the ring and small fingers. Note the ring finger proximal interphalangeal (PIP) joint flexion deformity due to the complete syndactyly between the border digits.

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(Images 24 and 25) Complete simple syndactyly of the ring and small fingers. Note the ring finger proximal interphalangeal (PIP) joint flexion deformity due to the complete syndactyly between the border digits.

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Media file 25: (Images 24 and 25) Complete simple ring and small finger syndactyly. Note the ulnar deviation of the ring finger due to the syndactyly of the small finger.

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(Images 24 and 25) Complete simple ring and small finger syndactyly. Note the ulnar deviation of the ring finger due to the syndactyly of the small finger.

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Media file 26: Paronychia in a patient with Apert syndrome. Despite the use of oral antibiotics and topical antibiotic solution, the paronychia did not fully resolve until the fingers were divided.

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Paronychia in a patient with Apert syndrome. Despite the use of oral antibiotics and topical antibiotic solution, the paronychia did not fully resolve until the fingers were divided.

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Media file 27: (Images 27-30) Left hand of a patient with Apert syndrome type II. The hand has already undergone a previous first-stage division. Bilateral releases were simultaneously performed to release the border digits along with deepening of the 1st webspaces using a 4-flap z-plasty.

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(Images 27-30) Left hand of a patient with Apert syndrome type II. The hand has already undergone a previous first-stage division. Bilateral releases were simultaneously performed to release the border digits along with deepening of the 1st webspaces using a 4-flap z-plasty.

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Media file 28: (Images 27-30) Volar view of the left hand of a patient with Apert syndrome type II. The hand has already undergone first-stage division. Bilateral releases were simultaneously performed to release the border digits along with deepening of the 1st webspaces using a 4-flap z-plasty.

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(Images 27-30) Volar view of the left hand of a patient with Apert syndrome type II. The hand has already undergone first-stage division. Bilateral releases were simultaneously performed to release the border digits along with deepening of the 1st webspaces using a 4-flap z-plasty.

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Media file 29: (Images 27-30) Left hand of a patient with Apert syndrome type II. This is a 6-month postoperative picture after second-stage release was performed for the central digits between the long finger and ring finger. Surgical release was performed with the standard zigzag incisions. Soft-tissue coverage for the phalanges was sufficient after the release; therefore, a pedicle groin flap was not needed. The long finger and ring finger shared a conjoint nail, which was also released successfully. This picture was taken during subsequent surgical revision of a tracheostomy.

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(Images 27-30) Left hand of a patient with Apert syndrome type II. This is a 6-month postoperative picture after second-stage release was performed for the central digits between the long finger and ring finger. Surgical release was performed with the standard zigzag incisions. Soft-tissue coverage for the phalanges was sufficient after the release; therefore, a pedicle groin flap was not needed. The long finger and ring finger shared a conjoint nail, which was also released successfully. This picture was taken during subsequent surgical revision of a tracheostomy.

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Media file 30: (Images 27-30) Dorsal view of the left hand of a patient with Apert syndrome type II. This is a 6-month postoperative picture obtained after a second-stage release was performed for the central digits between the long finger and ring finger. Surgical release was performed with the standard zigzag incisions. Soft-tissue coverage for the phalanges was sufficient after the release; therefore, a pedicle groin flap was not needed. The long finger and ring finger shared a conjoint nail, which was also released successfully. This picture was taken during subsequent surgical revision of a tracheostomy.

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(Images 27-30) Dorsal view of the left hand of a patient with Apert syndrome type II. This is a 6-month postoperative picture obtained after a second-stage release was performed for the central digits between the long finger and ring finger. Surgical release was performed with the standard zigzag incisions. Soft-tissue coverage for the phalanges was sufficient after the release; therefore, a pedicle groin flap was not needed. The long finger and ring finger shared a conjoint nail, which was also released successfully. This picture was taken during subsequent surgical revision of a tracheostomy.

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Media file 31: (Images 31-34) Dorsal view of the hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. The typical zigzag incisions are marked on both the dorsal and volar surfaces. Note the length of the dorsal trapezoidal flap design. Because it needs to be inset at a 45° angle with the distal edge of the web at the midlevel of the proximal phalanges, the length of the flap needs to be long enough to achieve this goal.

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(Images 31-34) Dorsal view of the hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. The typical zigzag incisions are marked on both the dorsal and volar surfaces. Note the length of the dorsal trapezoidal flap design. Because it needs to be inset at a 45° angle with the distal edge of the web at the midlevel of the proximal phalanges, the length of the flap needs to be long enough to achieve this goal.

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Media file 32: (Images 31-34) Volar view of the hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. The typical zigzag incisions are marked on both the dorsal and volar surfaces. Note the length of the dorsal trapezoidal flap design. Because it needs to be inset at a 45° angle with the distal edge of the web at the midlevel of the proximal phalanges, the length of the flap needs to be long enough to achieve this goal. Note the incidental simian crease.

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(Images 31-34) Volar view of the hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. The typical zigzag incisions are marked on both the dorsal and volar surfaces. Note the length of the dorsal trapezoidal flap design. Because it needs to be inset at a 45° angle with the distal edge of the web at the midlevel of the proximal phalanges, the length of the flap needs to be long enough to achieve this goal. Note the incidental simian crease.

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Media file 33: (Images 31-34) Hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. This picture was takenimmediately after the procedure. On the dorsal view, note the proximal skin graft on the ulnar and radial sides of the dorsal trapezoidal flap.

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(Images 31-34) Hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. This picture was takenimmediately after the procedure. On the dorsal view, note the proximal skin graft on the ulnar and radial sides of the dorsal trapezoidal flap.

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Media file 34: (Images 31-34) Hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. This picture was taken immediately after the procedure.

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(Images 31-34) Hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. This picture was taken immediately after the procedure.

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Media file 35: (Images 35-41) Dorsal view of left hand demonstrating a simple incomplete syndactyly between the long finger and ring finger. This incomplete simple syndactyly was released by using a V-to-M flap without the need for a skin graft. Note the markings.

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(Images 35-41) Dorsal view of left hand demonstrating a simple incomplete syndactyly between the long finger and ring finger. This incomplete simple syndactyly was released by using a V-to-M flap without the need for a skin graft. Note the markings.

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Media file 36: (Images 35-41) Volar view of left hand demonstrates a simple incomplete syndactyly between the long finger and ring finger. Immediate postoperative results are shown. Note the markings.

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(Images 35-41) Volar view of left hand demonstrates a simple incomplete syndactyly between the long finger and ring finger. Immediate postoperative results are shown. Note the markings.

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Media file 37: (Images 35-41) Dorsal view of a left hand demonstrates a simple incomplete syndactyly between the long finger and ring finger. Immediate postoperative results are shown.

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(Images 35-41) Dorsal view of a left hand demonstrates a simple incomplete syndactyly between the long finger and ring finger. Immediate postoperative results are shown.

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Media file 38: (Images 35-41) Immediate postoperative results are shown.

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(Images 35-41) Immediate postoperative results are shown.

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Media file 39: (Images 35-41) Immediate postoperative results are shown.

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(Images 35-41) Immediate postoperative results are shown.

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Media file 40: (Images 35-41) One month later, the hand has a sufficiently deepened web. However, hypertrophic and hyperpigmented scars are still present along the incision line.

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(Images 35-41) One month later, the hand has a sufficiently deepened web. However, hypertrophic and hyperpigmented scars are still present along the incision line.

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Media file 41: (Images 35-41) One month later, the hand has a sufficiently deepened web. However, hypertrophic and hyperpigmented scars are still present along the incision line.

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(Images 35-41) One month later, the hand has a sufficiently deepened web. However, hypertrophic and hyperpigmented scars are still present along the incision line.

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Media file 42: Skin-graft donor site. The donor site in the right inguinal region has healed well 10 months after the patient's syndactyly surgery. The graft harvested was able to resurface 2 web spaces during bilateral web-space releases. The incision is inconspicuous.

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Skin-graft donor site. The donor site in the right inguinal region has healed well 10 months after the patient's syndactyly surgery. The graft harvested was able to resurface 2 web spaces during bilateral web-space releases. The incision is inconspicuous.

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Media file 43: Hand of a 23-year-old patient who underwent releases of simple complete syndactyly of both the left third and fourth web spaces as an infant. The patient noticed progressive shortening of the web space and found it hard to wear protective gloves, necessary for employment in the fishing industry. This resulted in a poor fit of the glove and chronic irritation of the web. Note the radial deviation of the small finger due to the contracture from the patient's first surgery. The web space was deepened with local flaps and full-thickness skin grafts from the left groin.

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Hand of a 23-year-old patient who underwent releases of simple complete syndactyly of both the left third and fourth web spaces as an infant. The patient noticed progressive shortening of the web space and found it hard to wear protective gloves, necessary for employment in the fishing industry. This resulted in a poor fit of the glove and chronic irritation of the web. Note the radial deviation of the small finger due to the contracture from the patient's first surgery. The web space was deepened with local flaps and full-thickness skin grafts from the left groin.

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Media file 44: (Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft.

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(Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft.

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Media file 45: (Images 44-49) Hand of a 26-month-old patient with syndactyly who underwent release of a complete simple syndactyly of the left ring finger and long finger with flaps and full-thickness skin graft at 7 months of age. The patient developed hypertrophic scarring along the incisions, which persisted despite conservative treatment with topical steroid cream and scar massage. This contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation.

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(Images 44-49) Hand of a 26-month-old patient with syndactyly who underwent release of a complete simple syndactyly of the left ring finger and long finger with flaps and full-thickness skin graft at 7 months of age. The patient developed hypertrophic scarring along the incisions, which persisted despite conservative treatment with topical steroid cream and scar massage. This contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation.

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Media file 46: (Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft.

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(Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft.

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Media file 47: (Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft.

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(Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft.

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Media file 48: (Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft. At 3 months after surgery, he was doing well and had no evidence of recurrence.

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(Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft. At 3 months after surgery, he was doing well and had no evidence of recurrence.

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Media file 49: (Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft. At 3 months after surgery, he was doing well and had no evidence of recurrence.

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(Images 44-49) Hand of a 26-month-old patient who underwent release of a complete simple syndactyly between the left ring and long fingers with flaps and full-thickness skin grafts at 7 months of age. The patient developed hypertrophic scarring along the incisions. This persisted despite conservative treatment with topical steroid cream and scar massage. Contracture was present mostly along the ring finger, causing tethering of the distal ring finger with a mild radial deviation. The contracture was released with multiple Z-plasties and the web deepened with a small full-thickness skin graft. At 3 months after surgery, he was doing well and had no evidence of recurrence.

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Media file 50: Hand of an 18-year-old patient of Mediterranean heritage who had undergone multiple syndactyly releases with a full-thickness skin graft harvested from the groin as an infant. The skin graft can be observed as hyperpigmented patches within the web space. Some parts of the full-thickness skin graft also were noted to be hair bearing. Parents should be informed of the potential sequelae of the full-thickness skin grafts as the infant matures.

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Hand of an 18-year-old patient of Mediterranean heritage who had undergone multiple syndactyly releases with a full-thickness skin graft harvested from the groin as an infant. The skin graft can be observed as hyperpigmented patches within the web space. Some parts of the full-thickness skin graft also were noted to be hair bearing. Parents should be informed of the potential sequelae of the full-thickness skin grafts as the infant matures.

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Media file 51: Hand of an 18-year-old woman of Middle Eastern heritage who had undergone multiple syndactyly releases with a full-thickness skin graft harvested from her groin when she was an infant. The skin graft can be observed as hyperpigmented patches within the web space. Some parts of the full-thickness skin graft were also noted to be hair bearing. Parents should be informed of the potential sequelae of the full-thickness skin grafts as the infant matures.

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Hand of an 18-year-old woman of Middle Eastern heritage who had undergone multiple syndactyly releases with a full-thickness skin graft harvested from her groin when she was an infant. The skin graft can be observed as hyperpigmented patches within the web space. Some parts of the full-thickness skin graft were also noted to be hair bearing. Parents should be informed of the potential sequelae of the full-thickness skin grafts as the infant matures.

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Overview: Syndactyly

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References

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References

Schwabe GC, Mundlos S. Genetics of congenital hand anomalies. Handchir Mikrochir Plast Chir. 2004;36:85-97. [Medline].
Mandal K, Phadke SR, Kalita J. Congenital swan neck deformity of fingers with syndactyly. Clin Dysmorphol. Apr 2008;17(2):109-11. [Medline].
Flatt AE. The Care of Congenital Hand Anomalies. St Louis, Mo: Quality Medical Publishing; 1977.
Poland, Alfred. Deficiency of the pectoral muscles. Guy's Hospital Reports. 1841;VI:191-193.
Upton J. Apert syndrome. Classification and pathologic anatomy of limb anomalies. Clin Plast Surg. Apr 1991;18(2):321-55. [Medline].
De D, Narang T, Kanwar AJ, Dogra S. Brachycephaly and syndactyly: Apert's syndrome. Indian J Dermatol Venereol Leprol. Jul-Aug 2008;74(4):395-6. [Medline].
Patterson TJ. Congenital ring constriction. Br J Plast Surg. 1961;14:1–31. [Medline].
Percival NJ, Sykes PJ. Syndactyly: a review of the factors which influence surgical treatment. J Hand Surg [Br]. May 1989;14(2):196-200. [Medline].
Eaton CJ, Lister GD. Syndactyly. Hand Clin. Nov 1990;6(4):555-75. [Medline].
Lamb DW, Wynne-Davies R, Soto L. An estimate of the population frequency of congenital malformations of the upper limb. J Hand Surg [Am]. Nov 1982;7(6):557-62. [Medline].
Light TR. Congenital anomalies: syndactyly, polydactyly, and cleft hand. In: Peimer CA, ed. Surgery of the Hand and Upper Extremity. New York, NY: McGraw-Hill: 1996: 2111-44.
Man LX, Chang B. Maternal cigarette smoking during pregnancy increases the risk of having a child with a congenital digital anomaly. Plast Reconstr Surg. Jan 2006;117(1):301-8. [Medline].
Agarwal A. Comment on Shevtsov and Danilkin: Application of external fixation for management of hand syndactyly. Int Orthop. Jul 16 2008;[Medline].
Frick L, Fraisse B, Wavreille G, Fron D, Martinot V. [Results of surgical treatment in simple syndactily using a commissural dorsal flap. About 54 procedures]. Chir Main. Apr-Jun 2008;27(2-3):76-82. [Medline].
Upton J. Congenital anomalies of the hand and forearm: syndactyly. In: McCarthy JG, ed. Plastic Surgery. Philadelphia, Pa: WB Saunders Co: 1990: 5279.
Sharma RK, Tuli P, Makkar SS, Parashar A. End-of-Skin Grafts in Syndactyly Release: Description of a New Flap for Web Space Resurfacing and Primary Closure of Finger Defects. Hand (N Y). Sep 19 2008;[Medline].
Dillon CK, Iwuagwu F. Cavi-care dressings following syndactyly correction. J Plast Reconstr Aesthet Surg. Sep 24 2008;[Medline].
Barot LR, Caplan HS. Early surgical intervention in Apert's syndactyly. Plast Reconstr Surg. Feb 1986;77(2):282-7. [Medline].
Colville J. Syndactyly correction. Br J Plast Surg. Jan 1989;42(1):12-6. [Medline].
Wu JC, Cunningham BB. Ectopic acanthosis nigricans occurring in a child after syndactyly repair. Cutis. Jan 2008;81(1):22-4. [Medline].

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Keywords

syndactyly, simple syndactyly, incomplete simple syndactyly, complete simple syndactyly, complex syndactyly, complicated syndactyly, type I acrocephalosyndactyly, acrocephalosyndactyly, Apert syndrome, type I Apert syndrome, type II Apert syndrome, type III Apert syndrome, Apert's syndrome, Apert syndactyly, Poland syndrome, constriction band syndrome, polydactyly, cleft hands, ring constrictions, brachysyndactyly, symbrachyphalangisms, spade hands, mitten hands, spoon hands, rosebud hands, hoof hands, Holt-Oram syndrome, congenital hand deformity, congenital syndromes

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Contributor Information and Disclosures

Author

E Gene Deune, MD, Associate Professor of Orthopedic Surgery, Associate Professor of Plastic Surgery, Co-Director, Division of Hand Surgery, Director, Hand Surgery Section and Pediatric Hand Surgery, Johns Hopkins University School of Medicine
E Gene Deune, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Hand Surgery, American Association of Plastic Surgeons, American Society for Reconstructive Microsurgery, American Society of Plastic Surgeons, and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Medical Editor

A Lee Osterman, MD, Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael Yaszemski, MD, PhD, Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

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eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Syndactyly: Multimedia

Multimedia

(Images 1 and 2) Dorsal view of a hand demonstrating simple incomplete syndactyly between the left long finger and ring finger. Note the incidental café-au-lait spot.

(Images 1 and 2) Palmar view of the same hand with syndactyly. The level of the syndactyly, just proximal to the proximal interphalangeal (PIP) joint, can be clearly seen on the palmar view.

(Images 3 and 4) Dorsal view of the hand of a 1-year-old child with a complete simple syndactyly. Note that both the long finger and the ring finger have distinct nail plates with a trough separating them.

(Images 3 and 4) Palmar view of the hand of a 1-year-old child with a complete simple syndactyly.

(Images 5-7) Dorsal view of hand of a 6-month-old patient with type I Apert syndrome. Note that the thumb is separate.

Apert type II hand. Note the complete syndactyly between the ring and the small fingers. The patient's hand was complicated by a chronic paronychia and skin maceration preoperatively.

Apert syndrome (type III), dorsal view.

Apert syndrome (type III), volar view.

(Images 12 and 13) Poland Syndrome: Dorsal view of a left hand in a patient with Poland Syndrome with brachydactyly (short fingers) and adactyly (missing fingers) with associated simple incomplete syndactyly between the ring and the small finger

(Images 12 and 13) Volar view of the preceding hand in a patient affected with Poland syndrome.

(Images 14 and 15) Right hand of a patient with Poland syndrome. Note the incomplete syndactyly between the hypoplastic right index and long fingers.

(Images 14 and 15) Volar view of the index and long finger in incomplete syndactyly in a patient with Poland syndrome.

(Images 16-23) Dorsal view of the right hand of a 1.5-year-old patient with constriction band syndrome. The fingers can still be identified individually. Note the presence of a fistula tract between the affected fingers, particularly between the long finger and ring finger.

(Images 16-23) Palmar view of the right hand of a 1.5-year-old patient with constriction band syndrome. The fingers can still be identified individually. Note the presence of a fistula tract between the affected fingers, particularly between the long finger and ring finger.

(Images 16-23) Right hand of a 1.5-year-old patient with constriction band syndrome. Radiograph demonstrates that the level of the amputation occurred at the proximal interphalangeal (PIP) joints.

(Images 16-23) Radiograph of left hand of a 1.5-year-old patient with constriction band syndrome. The level of amputation is through the midportion of the proximal phalanges of the involved fingers.

(Images 24 and 25) Complete simple syndactyly of the ring and small fingers. Note the ring finger proximal interphalangeal (PIP) joint flexion deformity due to the complete syndactyly between the border digits.

(Images 24 and 25) Complete simple ring and small finger syndactyly. Note the ulnar deviation of the ring finger due to the syndactyly of the small finger.

Paronychia in a patient with Apert syndrome. Despite the use of oral antibiotics and topical antibiotic solution, the paronychia did not fully resolve until the fingers were divided.

(Images 27-30) Left hand of a patient with Apert syndrome type II. The hand has already undergone a previous first-stage division. Bilateral releases were simultaneously performed to release the border digits along with deepening of the 1st webspaces using a 4-flap z-plasty.

(Images 27-30) Volar view of the left hand of a patient with Apert syndrome type II. The hand has already undergone first-stage division. Bilateral releases were simultaneously performed to release the border digits along with deepening of the 1st webspaces using a 4-flap z-plasty.

(Images 31-34) Hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. This picture was takenimmediately after the procedure. On the dorsal view, note the proximal skin graft on the ulnar and radial sides of the dorsal trapezoidal flap.

(Images 31-34) Hand of a 1-year-old patient with complete simple syndactyly between his long finger and ring finger. This picture was taken immediately after the procedure.

(Images 35-41) Dorsal view of left hand demonstrating a simple incomplete syndactyly between the long finger and ring finger. This incomplete simple syndactyly was released by using a V-to-M flap without the need for a skin graft. Note the markings.

(Images 35-41) Volar view of left hand demonstrates a simple incomplete syndactyly between the long finger and ring finger. Immediate postoperative results are shown. Note the markings.

(Images 35-41) Dorsal view of a left hand demonstrates a simple incomplete syndactyly between the long finger and ring finger. Immediate postoperative results are shown.

(Images 35-41) Immediate postoperative results are shown.

(Images 35-41) Immediate postoperative results are shown.

(Images 35-41) One month later, the hand has a sufficiently deepened web. However, hypertrophic and hyperpigmented scars are still present along the incision line.

(Images 35-41) One month later, the hand has a sufficiently deepened web. However, hypertrophic and hyperpigmented scars are still present along the incision line.

Skin-graft donor site. The donor site in the right inguinal region has healed well 10 months after the patient's syndactyly surgery. The graft harvested was able to resurface 2 web spaces during bilateral web-space releases. The incision is inconspicuous.

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