Results of treatment
It is difficult to provide accurate data on treatment results, due to the heterogeneity of the condition, the many surgical techniques and the few long-term results published.
In simple syndactylies a good functional and cosmetic result is achieved (12, 20) – (22). However, a need for secondary procedures is reported in approximately 10 % of cases (12). Development of web creep occurred in two of 26 interdigital web spaces with the full-skin transplant technique after an 18-year follow-up period. (21). For the skin graft-free technique, long-term results after more than ten years’ follow-up show a somewhat higher occurrence of the development of web creep (22).
Goldfarb et al. (23) demonstrated good range of motion following the separation of complex syndactyly between the long and ring finger or between the ring and small finger. However, rotational and axial deviation of the fingers, and nail deformity with inadequate lateral nail-folds were found on most of the fingers. The study is supported by Vekris et al. (24), who found that complex and complicated syndactylies, together with delayed separation, give poorer results. In a study of Apert syndrome without use of distraction, acceptable functional results were found (25). All the patients required corrective procedures, but taking into account the complexity of the condition, the need for revisions was considered acceptable.
There are good results from using the «magic cube» to separate the last two fingers (18, 19). The creation of a «five-fingered» hand was achieved, with the long and ring fingers having an appearance corresponding to the other separated fingers. Of eight syndactyly operations (19) there were two minor infections which were treated with antibiotics, and one infection following completion of distraction, in which the distraction device had to be removed. In this instance the surgery for syndactyly was postponed for three weeks. In one case the separated synostosis fused together again during distraction and had to be reoperated.
The most frequent postoperative complications related to syndactyly surgery are infection and maceration of the graft or flap which can result in their loss. Loss of fingers is rare, but is described in the literature (12).