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Pathology

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The pathology of congenital syndactyly goes beyond simple fusion of skin with or without bone. Other structures may be hypoplastic or abnormally formed, creating problems for surgical correction:

  • absence of normal commissure which is difficult to construct given that it is made of non-hair-bearing dorsal skin that slopes at an angle of 45 degrees
  • digital arteries and nerves:
    • often shared between the two digits
    • the digital artery and nerve may bifurcate distally
    • the digital nerve can loop around the artery
  • connections between tendons eg pollex abductus between the flexor and extensor pollicis longus tendons
  • fascial bands may run between the two digits
    • composed of existing fascial structures such as Cleland's ligament, superficial palmar fascia or the intermetacarpal ligament
    • can attach to dermis
    • tend to constrict the growth of any longer digit involved in syndactyly causing flexion and deviation with growth
  • skin:
    • there is a shortage as the overall circumference of the two fused digits is less than the combined circumference of both digits in isolation
    • Kilian and Neimkin(1) reported a 22% deficiency of skin dependent on the design of the flaps for surgical correction
  • bones:
    • phalanges may be malformed, eg a triangular bone termed the delta phalanx
    • can be osseous fusion of distal phalanges or whole digit, seen in complicated syndactyly
    • bony deformity worsens with uncorrected growth due to the tethering effect of fascial interconnections
    • symphalangism of joints

 

Ref: (1) Kilian JT, Neimkin RJ (1985). South Med J 78: 414-418.


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