Procedure-specific guides
Syndactyly reconstruction
This page is for parents. It describes the separation of joined fingers and what follows, at home.
When it is done
The timing depends on which fingers are involved. When two fingers of unequal length are joined — thumb and index, or ring and little — separation is done early, often before the first birthday, because the longer finger bends as it grows.
When the fingers are of similar length, surgery can wait. If several webs are involved, it is done in stages: both sides of the same finger are never separated at once, so as not to compromise its blood supply.
- A skin graft is almost always needed, usually taken from the groin crease.
- The donor site heals on its own and leaves a fine, inconspicuous scar.
- Several affected webs mean several operations, spaced out over time.
After the operation, at home
Your child will have a bulky dressing, often a cast that goes above the elbow — that is deliberate: in a young child it is the only construct that does not come off by itself.
It must be kept completely dry for about three weeks, while the graft takes. Children cope far better than parents fear, and are back to their activities within days.
- Keep the cast dry: sponge baths rather than a shower or bath.
- Prop the hand up on cushions during sleep for the first few days.
- Call if the cast gets wet, slips, or develops a smell.
- Call if the visible fingers become cold, bluish or very swollen.
Follow-up through growth
Once the cast is off, scar care follows — massage and compression — and sometimes a night splint. Occupational therapy supports the child where needed.
Follow-up continues until growth is complete, for two reasons: the reconstructed web can gradually ride up as the hand grows, and a scar can tighten. Either is corrected with a revision, and it is planned rather than a surprise.
- Protect the scars from the sun during the first year.
- A revision later in childhood is common and anticipated.
- Encourage normal use of the hand: children adapt on their own.
Urgent
When to call, and who to call
Fingers that are cold, white or bluish, loss of sensation, severe and increasing pain that painkillers do not touch, a dressing that has become too tight, or bleeding that does not stop after ten minutes of pressure: go to the emergency department without waiting for a call back. For a fever, spreading redness or discharge, call the office the same day. If you are unsure, call 811.
Information on this site is general and does not replace a medical consultation. In an emergency, call 911.