Guatemala: OR Day 4

Source: Blog Post

4 of today’s cases were syndactyly releases.  Syndactyly is webbing or fusion of the digits, and it can affect the hand and/or foot and any webspace (although most commonly in the third webspace for the hand).  It can be seen in isolation or in association with other anomalies or syndromes.  2 of our patients (pictures 1-5) had Poland syndrome which has a characteristic chest wall deformity with absence of the pectoralis major muscle, and in the hand, we see synbrachydactyly, which are short fused digits.  For syndactyly of multiple adjacent fingers, we typically stage the separation to minimize risk of finger ischemia by only operating on one side of a single finger. 

Our third patient (pictures 6-7) had complex syndactyly from amniotic band syndrome which characteristically has tracts between the fingers from the distal fusions and preserved proximal webspaces.  Lastly, our fourth syndactyly patient of the day (picture 8-10)  had a complicated synpolydactyly of the 1st webspace and an incomplete simple syndactyly of the second web.

For these patients, syndactyly release includes separating the fingers, recreating the curve of the webspace with skin flaps, and resurfacing the areas between the fingers which usually requires skin grafts.  We placed these patients in casts for 2 weeks after surgery to protect the skin grafts while they are healing (last photo).