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Release of Fused Fingers

Release of Fused Fingers

Release of fused fingers, also known as syndactyly release, is a surgical procedure performed to separate fingers that are joined together by skin, soft tissue, or bone. Syndactyly is one of the most common congenital hand anomalies, occurring when fingers fail to separate properly during fetal development. The condition may involve only the skin (simple syndactyly) or include deeper structures like bones, tendons, and joints (complex syndactyly). Surgical release aims to restore the independent movement of the fingers, improve hand function, and create a more natural appearance.

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Causes and Associations

Syndactyly can occur as an isolated condition or as part of a syndrome. Causes include:

  • Genetic factors: autosomal dominant or sporadic mutations.
  • Syndromic associations: such as Apert syndrome, Poland syndrome, or Carpenter syndrome.
  • Environmental influences: less commonly linked to intrauterine factors.

Functional and Aesthetic Concerns

Fused fingers may not only limit hand function but also affect appearance, leading to social or psychological difficulties. Functional issues include:

  • Restricted finger mobility.
  • Problems with grasp, pinch, or fine motor skills.
  • Angular deformities due to uneven finger growth.
  • Difficulty in wearing gloves or handling tools.

Indications for Surgery

Surgical release is indicated in most cases of syndactyly to optimize function and hand growth. Timing depends on the severity and type:

  • Early surgery (before 1 year of age): if the border digits (thumb–index or ring–little) are fused, to prevent deformity caused by differential growth.
  • Standard timing (around 18 months–2 years): for other types, allowing safe anesthesia and good tissue handling.
  • Staged surgery: when multiple digits are involved, releases may be performed in phases to preserve blood supply.

Surgical Technique

The goal of surgery is to separate the digits while providing adequate skin coverage and preserving function.

  • Zig-zag or interdigitating incisions are designed to prevent contracture and create natural finger web spaces.
  • Skin and subcutaneous tissue are carefully dissected to separate the fused fingers.
  • In complex cases, bones, tendons, or neurovascular bundles are meticulously freed.
  • A new web between the digits is fashioned, often using local skin flaps for a natural contour.
  • There is usually insufficient skin after separation, so skin grafts (commonly full-thickness grafts from the groin or forearm) are used to cover raw areas.
  • The separated fingers are dressed individually with soft padding and sometimes splinted to maintain alignment.

Recovery and Rehabilitation

  • Hospital stay: Usually short, with discharge in a few days.
  • Dressings: Maintained for 2–3 weeks to protect the grafts and surgical site.
  • Physiotherapy: Introduced gradually to maintain mobility and prevent stiffness.
  • Follow-up: Regular monitoring to check for graft healing, scar formation, and finger alignment.

Children adapt quickly, and with proper rehabilitation, hand function improves steadily.

Outcomes and Prognosis

Most children achieve:

  • Independent finger movement, allowing better grip and dexterity.
  • Improved hand appearance, reducing social stigma.
  • Balanced growth of digits, preventing angular deformities.

Syndactyly release generally has excellent long-term results, though outcomes depend on whether the condition was simple or complex.

Risks and Complications

As with any surgery, complications can occur:

  • Skin graft failure or poor healing.
  • Scar contracture, leading to recurrence of webbing.
  • Neurovascular injury, though rare with careful technique.
  • Residual deformity in cases of complex syndactyly.
  • Need for secondary surgery, particularly if the child grows and fingers develop unevenly.

Special Considerations

  • Multiple digit syndactyly: Surgery must be carefully staged to preserve blood supply.
  • Associated syndromes: Additional deformities may require combined reconstructive strategies.
  • Psychological impact: Parental counseling and child support are important, as the condition and treatment affect self-esteem.

Conclusion

Release of fused fingers is a transformative surgical procedure that restores both the function and appearance of the hand. By carefully separating digits and reconstructing web spaces, surgeons provide children with the ability to grasp, pinch, and manipulate objects effectively. Though technically demanding and sometimes requiring staged procedures, the outcomes are highly rewarding, allowing children to develop normally and lead independent lives.

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Correction of Deformed Fingers

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