Case report: A late Syndactyly release
ABSTRACT
Syndactyly is the most common congenital malformation of the limbs, with an incidence of 1 in 2000-3000 live births.1 It is a failure of differentiation in which the digits fail to separate into individual appendages. The term syndactyly is derived from the Greek prefix syn- ("with, together") and the Greek noun daktylos ("finger, digit"). Surgery is warranted in almost all cases to improve function as well as a more cosmetically appealing digit as the child grows. Syndactyly release comes with complications such as infection, web creeps, graft failure and development of contractures.
Keywords: Syndactyly, congenital malformation, limb anomaly.INTRODUCTION
Syndactyly is a congenital hand anomaly deï¬ned by adjacent digits that fail to separate during embryological development. Fifty-seven percent of cases present in the third web space, and 50% of cases are bilateral. Syndactyly occurs because of the fusion of soft tissue with or without bony fusion. Based on which it may be classified as simple (without bone fusion) or complex (with bony fusion). Syndactyly is usually considered to be sporadic. However, with a family history an autosomal dominant pattern of inheritance does occur.
Syndactyly release is usually performed between 12 and 18 months of age. There is no gold standard repair/ reconstruction technique.
The most common procedures for reconstructing the web space—the most technically challenging aspect of repair—employ the use of a full-thickness skin graft from the groin region or dorsal metacarpalregion, although techniques without a skin graft are gaining popularity.2
However, all methods employ a common set of tech-niques that any surgeon must be comfortable with before attempting a repair. Techniquesinclude use of full-thickness flaps, triangular/zig-zag/rectangular incisions to separate dig-its, preservation of vascular supply to the digit, and a meticulous approach to reconstructionwith attention to preserving anatomic proportions and details.5,6
CASE REPORT
We report a case of a simple complete syndactyly of the left 3rd and 4th digits. 5-year old girl with no known medical illness nor syndrome presented with syndactyly of the left hand. She underwent syndactyly release surgery with skin grafting.
At post-operative 1 month follow up, wounds had healed well and range of motion at the interphalangeal joints was near normal compared to contralateral joints. During the course of wound healing she developed a mild superficial skin infection with resolved with topical antibiotics and dressing.
References:
- Malik S, Afzal M, Gul S, Wahab A, Ahmad M. Autosomal dominant syndrome of camptodactyly, clinodactyly, syndactyly, and bifid toes. Am J Med Genet A. 2010 Sep.