Removal of simple accessory digits may be possible with local anaesthetic while they are distracted by feeding, in a child under 3 months approximately. This falls under the umbrella of Congenital hand surgery.
For more significant congenital hand conditions such as thumb duplication a general anaesthetic procedure is necessary. This may be followed by splint wear for a couple of weeks.
Syndactyly (webbing) of the fingers usually requires treatment for reasons of function and from a technical point of view treatment begins in most cases after the age of 12 months. If more than one web is involved then adjacent ones are not usually treated at the same time to allow for shared blood supply. Extra tissue in the form of skin grafts is usually necessary. Polysyndactyly may also be present where there are extra bony digits present as well as the webbing. An individual plan for each child is necessary according to what is present in the hand. Surgery is usually followed by one week with plaster and dressing to protect the area. Full recovery may take three to four weeks.
Syndactyly of the toes is quite common and if incomplete and involving the second web (second and 3rd toes), early treatment is not usually recommended. If there are extra toes present that are likely to lead to problems with the fitting of footwear then each case is considered individually for treatment. X-rays to assess the anatomy are taken and a general anaesthetic procedure is needed if surgery is planned.
The time taken per procedure is variable, in line with the individual nature of this type of condition. The approximate time taken is two hours.
For the trigger finger or thumb, surgery may be necessary if the finger is fixed in position. But in some instances, referral to hand therapy may be suitable. If the response to wearing a splint at night is not helpful then surgery may be necessary. The wearing of splints for small children can be challenging to manage.
Congenital hand surgery is used to tackle a number of conditions in young patients.