Syndactyly Release - Information for paediatric day surgery patients

What is syndactyly?

You have been given this leaflet because your child has Syndactyly. This is a common condition where two or more digits (fingers and/or toes) are fused together or webbed. The fusion of these digits can be by either skin or skin and bone. It can be classed as ‘complete’ (the digits are fused along the whole length) or ‘incomplete’ (the digits are fused only partway). It can also be classed as ‘simple’ (where only soft tissue/skin is involved) or ‘complicated’ (where the underlying bones are joined together, but there are also extra bones). There can also be occasions where extra bones, tendons and ligaments have developed abnormally.

Why release a syndactyly?

Releasing a syndactyly, through surgery, involves cutting the skin covering two fingers to create separate fingers and a webspace and if necessary separating bones in the digits to help improve function as well as appearance of the digits. Some children can maintain good function of the digits without release. Separation of syndactyly of the toes is usually not required.

Before the operation

Initially, your child will be seen in clinic by a consultant plastic surgeon, and their name will be added to the waiting list at this point. Photos and X-rays are normally taken during this appointment.

In due course, you will receive a telephone call or letter to offer you a date and time to come in for your child’s surgery. You will also be given an appointment with the children’s pre-operative assessment clinic to check that your child is well for the surgical procedure. Additional tests will be arranged if needed, or they may be referred to an anaesthetist if necessary.

Please make sure that you have a supply of paracetamol and ibuprofen at home (if your child can take these) to give after the operation.

If your child becomes unwell prior to their surgery, please contact the admissions team as soon as possible to inform them, as the surgery may need to be postponed due to the increased risk of the anaesthetic.

When your child arrives on the ward

Please arrive on the ward at the correct date and time of admission for your child’s planned surgery. Please make sure that fasting instructions have been followed strictly, otherwise the surgery may not go ahead.

Please note that the time of admission to the ward is not the time your child will go down to theatre. The order of the operating list is organised by children’s ages and clinical needs, so it may be necessary to wait until it is your child’s turn.

A nurse will admit your child to the ward. This will include checking your child’s details, measuring their temperature, pulse and blood pressure, and checking whether they have any allergies. Depending on your child’s age, numbing cream may be applied to their hands, if they are going to be asleep during the operation, so that it is more comfortable when the cannula is inserted while your child is awake (if they are not having gas induction).

You will see the surgical team who will ask you to sign a consent form giving written permission to say you are happy for the procedure to go ahead. Prior to signing the consent form, the surgical team will discuss with you what the procedure includes as well as the risks and benefits of carrying out the surgery. You can also ask any questions that you may have about the procedure. The surgical team will also mark the site to be operated on with a surgical marker pen.

The anaesthetist will also see your child prior to going to theatre. They will check that your child is medically fit for both the procedure and the general anaesthetic (if your child is having this). They will also discuss with you the different ways that anaesthetic can be given, and which method would be best for your child.

Your child will change into a gown to go to theatre.

You can accompany your child to the anaesthetic room and stay while your child goes to sleep but you will not be able to accompany your child into the operating theatre. A member of staff will take you through to recovery, where recovery staff will take a contact number to call you on to inform you when your child is in recovery.

In the operating theatre

If your child did not have a cannula inserted into their hand in the anaesthetic room, they will have one inserted once they are asleep. This is so that medications can be given intravenously during the operation and after surgery, if required.

Once your child is asleep, local anaesthetic is injected into the area to be operated on; this will ensure that your child is comfortable after the operation.

Cuts, usually in a zig-zag shape, will be made to the skin attaching the digits together. The skin is used to make flaps to separate the digits, to make a webspace (skin between the fingers) and to cover the digits. If there is not enough skin to fully cover the digit a skin graft may be needed. If this is the case a small piece of skin is taken from elsewhere on the body. This is usually from the groin, where any residual scarring is less likely to be seen. This used is used as a graft to the area of the digit that does not have enough skin to cover it. The area where the extra skin is taken from is stitched together, usually with dissolvable stitches, and a splash proof dressing is applied over the top. You should be aware that the colour of the skin graft may differ slightly to the colour of the digit skin.

The whole area operated on will be covered by a dressing within a bulky bandage, to protect the syndactyly repair until it reviewed in the dressings clinic, the area where the skin was taken from will also be reviewed at this time.

Post-op

You will be contacted by recovery when your child is starting to wake up.

After surgery your child may feel drowsy or sleepy, they may be restless and upset after waking from surgery. This normally settles on its own.

Your child can eat and drink as soon as they feel able to after the procedure.

There may be swelling and bruising to the area. This will go down with elevation of the limb and should settle down over the following days or weeks. We recommend keeping the operation site elevated as much as possible following the operation, to help reduce swelling, which in turn helps to reduce pain.

You may go home once your child has eaten, drunk liquid and passed urine. We will also make sure that your child is comfortable after the procedure, before they go home.

After you go home

Paracetamol and ibuprofen should be given regularly for the first couple of days. Please discuss this with staff if you are unsure about the amount of pain medication to give.

The dressing will need to be kept dry.

Keep the limb elevated as much as possible, to reduce swelling to the limb and to alleviate pain.

It is normal for there to be some ooze from the wound after surgery. If there is any fresh blood visible, please contact the children’s plastic surgery Clinical Nurse Specialist or attend A&E.

Your child will have a follow up appointment in the children’s dressings clinic for a dressing change.

Your child will also have a follow up appointment with a plastic surgery consultant.

Medication

Please bring all of your child’s medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your child’s GP.

Please tell the ward staff about all of the medicines your child uses. If your child wishes to take their medication themselves (self-medicate) or you wish to give them their medication during their stay, please speak with their nurse first. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

If you are interested in this please let us know and we can provide information, or look on our website: MyChart

Contacts/Further information

Paediatric Plastic Surgery Clinical Nurse Specialist

Tel: 07729 107964

Email paediatric plastic surgery

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.