Paediatric
Syndactyly
Fingers · separation
What it is
Syndactyly is the joining of two or more fingers, present at birth. It happens when the fingers do not separate completely during the early development of the hand.
It is called simple when only skin and soft tissue are involved, and complex when the bones are joined as well. The space between the middle and ring fingers is most often affected. Syndactyly may occur on its own or as part of a syndrome, which guides the initial assessment.
Symptoms
The fingers are joined over a variable length, sometimes as far as the nail. The hand often works surprisingly well in infancy, and the limitations show up mainly in fine tasks and in grasping wide objects.
One point deserves attention: when two fingers of unequal length are joined — thumb and index, or ring and little — the longer finger is progressively tethered and bends as the child grows. That is what makes earlier separation appropriate in those cases.
Non-operative treatment
There is no non-surgical way to separate joined fingers. The time before surgery is used to confirm the anatomy, plan the timing, and complete any further assessment that is needed.
Occupational therapy can support the child in adapting, but it does not replace separation where that is indicated.
Surgical treatment
Separation is done with zigzag skin flaps, designed so that no scar crosses a flexion crease in a straight line. The web — the hollow between the fingers — is rebuilt with a local flap so that it has the depth and shape of a normal web.
A skin graft is almost always needed: two joined fingers do not carry enough skin to cover two separate ones. Fingers of unequal length are separated first, often before the first birthday. Only one side of a finger is separated at a time, to protect its blood supply.
Recovery expectations
A protective cast is worn for about three weeks while the graft takes. Dressing changes follow, along with scar care — massage and compression — and therapy.
Two things are watched over the long term: the web slowly riding up as the child grows, and scar tightening. Either can call for a revision later in childhood. Follow-up therefore continues until growth is complete.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.