Fused fingers (Syndactyly) is an abnormal connection between the fingers or toes and is considered a common congenital defect. The most common cases involve the adhesion of the middle finger and ring finger. However, it can also include other fingers, such as the thumb and index finger. Adhesion can occur on more than two fingers as well. Adhesion can be complete, involving the entire fingers, or it may only involve a portion of the fingers. It can be limited to the skin or may include adhesion in the bones as well.

 

Syndactyly is a condition in which children are born with fused fingers. About half of the children with fused fingers have this congenital defect in both hands, meaning it is bilateral. Most commonly, fused fingers affect the fingers of the hands. Occasionally, it also affects the toes, but not as frequently. Fused finger are somewhat common, affecting approximately 1 in every 2500 children. This congenital defect tends to affect boys more than girls. It also affects Caucasian children more than African American or Asian children.

 

During pregnancy, the baby's hands initially form paddle-like structures. Later, they split into separate fingers. It is normal for this separation to occur very early, around the sixth to eighth week of pregnancy, which means that after about 56 days of pregnancy, the hand takes its final shape. During the final stages of growth, all the fingers should be separated. Usually, the skin connections disappear before 56 days.

 

However, if this separation does not occur properly, the skin connections persist, and this is what we call "fused fingers." Fused fingers condition occurs when one or more fingers do not separate during this time. 

 

In most cases, parents can do nothing to cause or prevent this congenital defect. Fused fingers condition often runs in families. About 10 to 40 percent of children with Fused fingers inherit the condition from one of their parents. In some cases, Syndactyly is part of a genetic syndrome, such as Poland or Apert syndrome.

 

The symptoms of fused fingers vary depending on the type your child is experiencing. According to the severity of the adhesions, there are three types of fused fingers: simple, moderate, and complex.

• Simple fused fingers; the fingers are connected only by the skin and soft tissues.

• Moderate fused fingers; the fingers are connected by bone as well.

• Complex fused fingers; additional bones, tendons and ligaments may have developed abnormally.

 

Children with fused fingers typically cope differently, and the more fingers affected, the more challenging the function may be. The primary functional problem in fused fingers is difficulty holding large objects or grasping and maintaining a grip on round objects because the fingers do not separate as they typically would.

Additionally, the hand may look different with fused fingers, which can bother the child and potentially alter how others relate to and perceive him, affecting his interactions. In some children, this can lead to psychological stress and decreased self-confidence.

 

Syndactyly is often diagnosed at birth. Sometimes it is detected early through prenatal ultrasound.

Dr. Wael Ghanem, a consultant in plastic surgery and congenital defect repair, may use X-rays to evaluate the underlying structure of your child's fingers and determine the optimal treatment approach.

 

The only way to correct fused fingers is through surgery, which aims to separate the fused fingers by separating the nerves, blood vessels, and joint tendons. The timing of the surgery depends on various factors. When the adhesion involves the thumb and index finger or the ring finger and little finger, it is preferable for the child to undergo the procedure between six and nine months old, as early surgical intervention helps restore natural movement without scars.

The surgical treatment is performed under general anesthesia, meaning your child will be asleep and will not feel any pain. Usually, only one side of the finger is separated on at a time to avoid any harm to the blood supply on both sides.

 

• During the surgery, the skin is divided evenly between the fingers, which typically involves creating a series of curved incisions along the fingers and wrapping the curved cut pieces of skin to cover the inner surface.

• Your child may require skin grafting to fully cover the fingers after separation and fill any remaining gaps, aiming to improve the appearance and function of your child's fingers. Typically, the skin graft is taken from non-visible areas such as behind the ear, the lower abdomen, or the inner thigh to minimize scarring in the future.

• During the separation, care is taken to ensure each finger receives its natural blood supply and nerve innervation.

• To avoid potential complications and prolonged surgical time, only one side is separated in each surgery. If your child has adhesions on multiple fingers, he will require more than one surgery.

• Your child will return home on the same day of the surgery.

 

After the surgery, your child will wear a cast or dressing that covers his hand and extends to his forearm and elbow for two to three weeks to keep his hand stable and protect the healing skin.

About two weeks after the surgery, Dr. Wael Ghanem will examine your child's hand, and another examination will take place six weeks after the surgery. During the first visit after two weeks, your child's long cast will be removed. Once it is removed, most children won't need bracing or hand treatment. Some cases may require wearing a brace to keep the fingers separated for six weeks.

 

Your child will need to return to Dr. Wael Ghanem for several annual visits throughout early childhood to ensure normal hand function development, which is particularly important for learning skills like writing and engaging in physical activities.

Syndactyly requires regular follow-up visits with Dr. Wael Ghanem and his medical team to ensure best hand healing and moving. The medical team may need to see the child for several years.

Encourage your child to practice age-appropriate activities once the surgical incisions have healed. Do not restrict your child's use of his hand, as it may lead to stiffness of the fingers and increased scarring.

 

Surgery is the only option for separating fused fingers. The goal of the procedure is to improve hand function, meaning enhancing the child's ability to use his hand well, and sometimes it aims to improve appearance, which refers to how the child's hand looks. Dr. Wael Ghanem, the plastic surgery and congenital defect repair specialist, will advise performing the surgery if the benefits to the child are functional, cosmetic, or both. Therefore, don't hesitate to consult the best plastic and congenital defect repair surgeon in Egypt.