European Journal of Cardiovascular Medicine

syndactyly is most common.1 Syndactyly word derived from 2 Greek word “Syn” means together and “Dactylos” means digit. Syndactyly is described as fusion of soft tissue, skeletal elements or both elements in variable degree of adjacent digits. Syndactyly occurs when digital separation and websspace creation is failed to occur during 4-8 weeks of development of hand.

Incidence of syndactyly is 1 in 2000 to 1 in 3000 life birth approximately2. Males are 2 times more common than female. Isolated syndactyly is most common in 3rd webspace between ring and middle finger (50%), followed by 4th webspace between ring and little finger (30%), followed by 2nd webspace (10%) between index and middle finger and least common is 1st webspace between thumb and index finger (5%)3. In Syndromic, case 1st web space involvement is more common than 2nd web space & other web spaces. In foots, involvement 2nd web space between 2nd and 3rd toe is most common than other web space. Majority of syndactyly are isolated. But familial in 10-40% of cases4.Most common genetic inheritance is autosomal dominant with incomplete penetrance.5

Syndactyly may be congenital present since birth by developmental abnormality or acquired after birth by burn or trauma.

Main aim of Surgery is to separate fingers, creation of webspace, cover joint with flap, cutaneous cover of both finger with a functional hand with few complications.

Study has been conducted in different part of world and India about syndactyly. But in Odisha no such study has been conducted. So we have conducted our study to assess clinico-epidemiological profile of syndactyly patients in a tertiary care centre in Western Odisha.

It was a prospective study conducted in department of plastic surgery VIMSAR Burla, a tertiary centre in Western Odisha between 1stJuly 2022 to 31st December 2023 a period of one and half years. 20 syndactyly patients were included in the study.

Inclusion criteria-

All patients of syndactyly admitted to indoor were included in the study.

Exclusion criteria-

Cases with other severe congenital malformations were excluded from study.

All patients of syndactyly admitted in indoor detailed history was taken. Patients information like age, sex, family history, whether congenital or acquired were collected. In case of acquired case cause of syndactyly whether following burn or trauma history was collected. A thorough clinical examination was done. Type of syndactyly was found out, complete or incomplete, unilateral or bilateral, involvement of only hand or foot orboth was found out. X-ray done to know syndactyly was simple or complex. Other congenital anomaly ruled out. Cardiology done to exclude congenital heart diseases. Counselling about detailed surgical procedure, complications during surgery and after surgery was done. After patients were fit for surgery, operation was planned.

In all cases dorsal quadrangular flap and ventral V flap was planned. Finger separated by Cronin’s incision with a plan to cover proximal and distal interphalangeal joint with skin flap. Marking of incision given. Under tourniquet control after elevation of dorsal and ventral flap finger were separated by Cronin’s Zigzag incision safeguarding the neurovascular structure.  Fingertip were separated by inter-digiting flap described by Buck-Gramcko. Webspace created by apposing dorsal and ventral flap. Flap from ventral and dorsal part of skin used to cover proximal and distal interphalangeal joint. Rest raw area left were covered with skin graft. Dressing was done with separate dressing for each finger. 1stdressing was done after 5 days and dressing was done on alternate day after that. Patients discharged after 7-10 days. Follow up of patients done every weekly for first 2 weeks, then weekly for 2 months and then monthly for 6 months to check out any complications like graft loss, hypertrophic scar, web creep, contracture of fingers etc.

20 patients included our study.

Table 1: Sex pattern

Table-1 described distribution of syndactyly between male and female. It was found that males were most commonly affected than female with male female ratio 1.1:0.9

Table 2: Age of presentation

Table-2 described age of presentation. Most common age group affected was more than 20 years of age (40%), followed by 0-5 years age group (25%), followed by 6-10 years (20%), followed by 11-15 year(10%) and least common age group between 16-20 years (5%).

Table- 3: Etiology of syndactyly

Table-3 described aetiology of syndactyly. It was found that most cases were congenital in nature i.e. in 15 out of 20 cases (75%) and 5 cases were acquired following burn i.e. in 25% of cases.

Table 4: Involvement of limb

Table 4 described involvement of part of body. Hands were most commonly affected than foot.  In 13 cases only hand was involved i.e. in 65% of cases, in 5 cases only foot was involved i.e. in 25% cases and in 2 cases both hand and foot was involved i.e. in 10% cases. In hand bilateral hand involvement was most common 9 out of 15 cases i.e. in 60% cases, followed by Left hand only in 4 cases i.e. 26.6% of cases and right hand only was involved in 2 cases i.e. in 13.33% of cases. In foot both foot involved in 4 out of 7 cases i.e. in 57.1% cases, right foot only in 2 cases i.e. in 28.57% cases and left foot only in 1 case i.e. in 14.3% cases.

Table 5: Types of Web space in syndactyly

Table 5 described type of syndactyly. Total 35 web spaces were operated in 20 cases. Most of the syndactyly were simple in nature. Out of 35 web spaces, 27 were simple in nature i.e. in 77.14% cases and 8 were complex in nature i.e. in 22.86%. Out of 27 simple web spaces, 17 were complete and 10 were incomplete. All cases of complex webspace were complete in nature. So total 25 were complete i.e. in 71.4% cases and 10 are incomplete i.e. in 29.6% cases

Table 6: web space involved

Table 6 described web space involvement.24-web space was operated in hand in 15 patients.  It was found that 3rd web space was most commonly involved hand (62.5%) followed by 4th web space (25%), followed by 2nd web space (8.33%) followed by 1stweb space (4.16%).  11-web space were operated in 7 patients in foot. 2nd web space was involved in 6 cases i.e. 54.54% of cases, 1stweb space in 3 cases i.e. in 27.27% of cases and 3rd and  4th web space in  1 case each i.e. in 9.09% of cases.

Table 7: Complications

Table 7 described complication following surgery. It was found that most common complication in our study was hypertrophic scar in 6 out of 35-web space i.e. in 17.14%. 2nd most common complication was graft loss i.e. in 11.42%, contracture in 8.57%, flap tip necrosis and web creep in5.7%, fingertip deviation in 2.8% of web space operated. In no cases neurovascular injury occurred. All cases of graft loss healed spontaneously without any further intervention required.

[Fig.1(a) & (b): complex complete syndactyly] [Fig. 2(a) & (b): planned incision marking]

[Fig. 3(a) & (b): release of syndactyly]  [Fig. 4(a) & (b): flap suturing & placement of graft]