Syndactyly is a congenital abnormality of the fingers or toes, which is a complete or partial fusion of two or more fingers. Sometimes the disease is complicated by their deformation and underdevelopment (the nail bed or phalanx may be absent).
The cause of syndactyly is an anomaly in the embryonic period of bone formation during pregnancy. The disease is diagnosed in one baby out of 2,500 newborns, and boys suffer from this disease almost twice as often as girls. Every second baby with syndactyly is diagnosed with additional skeletal developmental anomalies (hypoplasia of the fingers, flat feet, foot deformity, etc.).
The main consequence of syndactyly is a cosmetic defect that can be eliminated in the only way - surgical separation of the fingers. In this case, it is possible to perform partial plastic surgery to restore missing tissue.
Lack of timely treatment for syndactyly can cause irreversible consequences in the development of the child’s limbs, his mental and intellectual development.
Is it possible to recognize syndactyly on your own?
Yes it is possible. Syndactyly is clearly visible to the naked eye. The neonatologist makes a preliminary diagnosis after the initial examination of the child. Further diagnostics will be carried out to clarify the type of syndactyly.
X-ray examination is the simplest and most informative procedure. X-rays will show whether the fingers are connected only by skin and soft tissue, or whether bones are also involved. In more severe cases, an MRI or CT scan may be required. Tomography provides more detailed information about the structure of the bones.
In some cases, signs of syndactyly are detected in utero, during mandatory ultrasound screening examinations during pregnancy. The skin bridges between the toes usually disappear before the 56th day of pregnancy. Their detection at a later date indicates syndactyly.
What types of syndactyly are there?
Not all cases of syndactyly are the same. It can be complete (fingers fuse along the entire length) or incomplete (only individual phalanges of the fingers fuse). Depending on which fingers are involved in the process, there are 5 types of the disease:
- Zygodactyly, type 1 is the most common form of pathology. It is characterized by fused ring and middle fingers.
- Synpolydactyly, type 2, also affects the ring and middle fingers - they grow together, and an additional ring finger appears.
- Ring and little finger syndactyly, type 3, usually affects both hands at the same time. In more severe cases, the distal phalanges may fuse.
- Haas syndactyly, type 4, is a rare form of pathology in which all fingers are fused. The hand becomes deformed and takes on the shape of a bowl.
- Type 5 is a combination of a fused ring and middle finger with a fused second and third toe.
Syndactyly is an exclusively congenital pathology. It may also be a component of complex genetic syndromes, such as Saethre-Chotzen syndrome and Apert syndrome. In this case, correction of the fingers can be carried out at a later date, giving way to the treatment of pathologies with a higher health risk (for example, heart disease).
How is the treatment carried out?
Treatment for syndactyly involves surgery; there is no other effective way to separate the fingers. A timely operation performed in a good medical institution allows you to achieve the following results:
- Improving the appearance of the hand, correcting a cosmetic defect.
- Prevention of progression of pathology during arm growth.
- Preservation of normal function of the upper limb.
The operation is not limited to a simple incision because the available skin is often not enough to cover the surface of two separate fingers. Thus, the skin defect is carefully restored using several skin flaps. Sometimes skin grafting is required to cover the entire surface and provide a good cosmetic and functional result. Skin grafts can be taken from the thigh or the front of the elbow. Another option is to use skin from the top of the hand, which is more resistant to injury and prevents scarring.
In cases where syndactyly affects the bones of the fingers, more complex intervention is required. Bone joints usually form next to the nails and can often be separated in the same way as simple folds of skin. The problem is that after such intervention the fingers usually remain deformed (for example, spread out or bent). In this case, additional surgical interventions are performed.
The appropriate age for treatment depends on the type of syndactyly. If the ring finger and little finger or thumb and index finger are fused, surgery is performed as early as possible (at about 6 months of age). Other types are less functionally significant and can be treated at a later age (up to 2 years).
Causes
The causes of syndactyly have been studied in detail - the fetus has a physiological pathology in the first stages of its life, that is, at 4–5 weeks of its development inside the mother. And later (7–8 weeks) separation of the fingers should occur due to the rapid growth of the radiocarpal bones, accompanied by a slowdown in the growth of tissues between the fingers, but this action does not occur for some reasons.
Like other intrauterine developmental defects, syndactyly develops due to certain reasons:
- an anomaly at the genetic level, which is transmitted in an autosomal dominant manner, and often fused fingers are accompanied by other pathologies in the skeletal system (cryptophthalmos, oculodental-osseous dysplasia);
- unfavorable course of pregnancy;
- work in hazardous production;
- alcoholism of the mother or father;
- living in contaminated areas;
- consumption of toxic substances that may be contained in medications or food.
Is it necessary to visit a doctor regularly after treatment?
Yes, you will need to visit the clinic regularly for the first few months. Immediately after surgery, the arm will be protected with a voluminous soft bandage covering the arm and forearm. An additional rubber pad may be placed between the affected toes to prevent recurrence of syndactyly while the wound is healing.
One of the main tasks of the postoperative period is the prevention of scar formation. During the healing process, the skin may be replaced by connective tissue. Connective tissue effectively and quickly covers the surface of the wound, but cannot stretch. Thus, the fingers lose their normal shape and function. In such cases, a repeat operation is performed.
In specialized clinics abroad, physiotherapy is mandatory during rehabilitation. It helps to avoid stiffness and swelling and restore normal range of motion. All procedures are performed under the strict supervision of a qualified medical professional.
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3. Symptoms and diagnosis
Syndactyly can be simple (fusion of normal soft tissues, membranous junction or common skin sheath) or complex when there is common bone tissue, undivided nails, and associated structural defects of the hand or foot. At the stage of intrauterine formation, two or more fingers may not separate.
Fused toes are diagnosed during a neonatal examination at birth. In some cases, syndactyly can be visualized already during intrauterine ultrasound, especially if there are grounds for suspicion and the study is carried out purposefully. To clarify the situation, additional diagnostic tests (x-rays, etc.) are prescribed.
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Which clinics are leading in the treatment of syndactyly?
Clinics in European countries with developed medicine are leaders in the field of plastic surgery. Equipment for precise (down to the cellular level) interventions, 3D planning of optimal aesthetic results and high competence of surgeons contribute to the best treatment results. Plastic surgery in Germany combines low risks and optimal functional results, which is extremely important when treating children.
The list of the best clinics in Germany that demonstrate outstanding results in the treatment of syndactyly includes:
- HELIOS Clinic Krefeld, Department of Plastic, Aesthetic and Reconstructive Surgery.
- University Hospital of the University of Munich. Ludwig Maximilian, Department of Hand Surgery, Plastic and Aesthetic Surgery.
- Oberberg Waldbröll Clinic, Department of Otolaryngology, Plastic Surgery, Facial Surgery.
German clinics provide assistance to children and adults with this pathology. Doctors also perform revision interventions and correct complications after previous operations (this is a common situation in children who are treated in non-core medical institutions). Specialists in Germany always develop an individual, comprehensive treatment program - from initial diagnosis to full functional recovery after surgery.
Organization of treatment in leading foreign clinics
If you want plastic correction of your child’s fused fingers to be performed in Germany, you need to resolve a number of issues. The first is to choose the most suitable clinic and obtain permission for treatment there. Treating children is a big responsibility, and not all clinics and doctors are ready to accept it. You should also take care of all medical and administrative documents related to traveling abroad for treatment. Please pay attention to the translation of documentation - medical reports must be in German. After this, you can begin to find an interpreter who will accompany you in the clinic.
You can undergo surgery to restore the appearance and function of the hand at the Helios Clinic Berlin-Buch. The Department of Pediatric Surgery, under the direction of Prof. Dr. med. Klaus Schaarschmidt, successfully performs operations on young children with all types of congenital hand defects. The pediatric surgeons of the department remove additional phalanges and fingers for polydactyly types I-VII, and separate fused fingers for syndactyly. If necessary, skin grafting from the thigh or forearm is also performed - this allows you to completely restore the function of the hand and prevent the development of postoperative contracture as the child grows.
Considering that hand pathologies are often found in complex genetic disorders, the department’s specialists pay special attention to a comprehensive examination, involving specialists in related fields in this process. As a rule, hand surgeries are performed in a hospital setting. For the convenience of parents and children, the clinic offers a Rooming-in placement system, when a small patient and one of his parents are located in the same room.
An easier and more convenient way to organize treatment is to use the professional help of Booking Health. Booking Health is a certified medical tourism operator that organizes treatment abroad for children and adults from 75 countries. Booking Health doctors and coordinators will assist you in the following matters:
- Choosing the right clinic for your child
- Communication with a doctor, agreement on a preliminary treatment plan
- Providing favorable cost of treatment, without surcharges and coefficients for foreign patients (savings up to 50%)
- Sign up for surgery on the desired date
- Additional independent control of the treatment program
- Communication with the clinic after completion of treatment, organization of follow-up examinations and remote consultations
- Strict control of accounts and return of unspent funds
- Booking accommodation and air tickets, organizing transfers
- Translation services
In addition, your personal medical coordinator will stay in touch with you 24 hours a day. You will feel confident and protected while treating your child.
1.General information
The term “syndactyly” translated from Latin means a joint, combined position of the fingers or, more simply, fused fingers. This is a congenital pathology, which has many varieties, occurs under the influence of various factors and, according to statistics, occurs with an ever-increasing frequency. In different regions of the world, syndactyly is detected in 0.02% -2% of newborns.
According to some sources, the likelihood of such an anomaly does not depend on gender; according to others, it is higher in boys. Syndactyly on the legs is much less common than on the hands. Often, fused fingers are not the only anomaly of intrauterine development and are observed in combination with other developmental defects, for example, the musculoskeletal system. And syndactyly is always eliminated (if elimination is at all possible) by microsurgical intervention.
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