Definition
Webbed fingers
Aetiology
Usually spontaneous but can be inherited
Due to a failure of separation during embryonic development
Epidemiology
Most common congenital hand abnormality 1:2000
Family History in 20-40% / AD
Associations
Polydactyly
Amniotic bands
Toe webbing
VECTRAL
Craniofacial abnormalities
Apert's syndrome
Classification
Simple / Complex
- simple skin only
- complex has bony involvement
Complete / Incomplete
- extent of finger involved distally
DDx
Acrosyndactyly
- fusion of fingers distally with proximal fenestrations
Brachysyndactyly
- shortening of syndactyl digit
Anatomy
Middle & ring finger commonest 60%
Thumb & index rarest
- Apert's
Bilateral in 50%
Frequent anomalous sharing of
- musculotendinous structures
- artery / veins / nerves
Management
Timing
Surgery aged 1 year
- minimise bony deformity
- especially if thumb / index as in Apert's syndrome
- once child safe for anaesthetic
Important surgical principles
1. Beware NV abnormality
- usually normal number in simple syndactyly
- may be absent in complex
- may divide much more distally
2. Skin shortages
- may need FT skin graft
3. Release one side at a time
- may jeopardise vascularity to finger
- 3/12 between each side
4. Need to create web space
- Zig Zag incisions with volar or dorsal flap for web space (Vickers)
- important not to deepen web space too much as looks unsightly
- web space deepening often limited by digital artery bifurcation
5. Division of border digits done early to avoid angular deformity
Complications
Clinodactyly
- due to shortening of graft
- not seen with Vickers technique
Web creep
- return of webbing
- revise as teenager so only need one further surgery
- web space reconstruction
Neurovascular injury