An Interesting Case of Pediatric Surgical Management of Polydactyly and Syndactyly

A poster case presentation from doctors at Jamaica Hospital Medical Center demonstrated that meticulous reconstructive surgery using full-thickness plantar-dorsal rotational flaps and autologous ankle skin grafts can effectively manage concomitant polydactyly and syndactyly in a pediatric foot, achieving durable functional and aesthetic outcomes. The report, authored by Julius Bautista, DPM; Anuj Paul, DPM, AACFAS; and Tomasz Rostkowski, DPM, ABFAS, emphasized that early intervention using this approach may reduce long-term complications such as gait instability, shoe discomfort, and psychosocial distress.

Surgical Approach and Case Details

The case involved a 21-month-old female presenting with fused and supernumerary toes on the left foot, causing irritation, pain, and difficulty wearing shoes. The child’s mother reported recurrent skin breakdown due to friction along the medial and lateral aspects of the affected foot.

Following radiographic evaluation confirming soft-tissue syndactyly and bony polydactyly of the first and second digits, surgeons performed a combined excision and reconstruction. The procedure included:

• Surgical removal of the extra digit using precise dissection and closure with full-thickness flaps.
• Autograft harvest from the same foot’s lateral region to minimize donor-site morbidity.
• Reapproximation of the flaps for web space reconstruction using absorbable sutures to improve cosmesis and avoid external suture removal.

Postoperatively, the patient transitioned from a surgical shoe to full weight-bearing within weeks. Dressings were carefully applied to prevent adhesion between grafts and gauze.

After follow-up, the team reported that the child exhibited pain-free ambulation, improved toe alignment, and excellent graft integration without infection or wound breakdown. The authors also noted the patient’s improved gait stability and tolerance for standard footwear.

Clinical Discussion and Implications

The authors shared that polydactyly and syndactyly are among the most frequent congenital digital malformations, occurring in approximately 1 in 2,000–3,000 births. The condition can cause not only mechanical difficulties but also emotional distress due to appearance or mobility issues.

The team highlighted that surgical correction during early childhood could potentially allow for optimal soft-tissue remodeling and prevent secondary deformities. The combined flap and graft technique reduced scarring, avoided secondary donor sites, and maintained foot contour. Notably, using skin harvested from the same limb eliminated visible scarring at distant sites such as the thigh or calf and shortened operative time in this case.

Furthermore, the approach reduced tension across the incision, preventing ischemia and flap necrosis—a common challenge in pediatric reconstructive cases. Postoperative compression and strapping stabilized correction and minimized recurrence risk.

In Conclusion

This case demonstrates that single-stage correction of pediatric polydactyly and syndactyly using autologous ankle skin grafts and full-thickness rotational flaps can yield both functional and cosmetic success. The patient in this case achieved a stable, pain-free gait with restored digital separation and no postoperative complications.

The authors conclude that this minimally invasive reconstructive method “improves patient satisfaction, decreases recurrence rates, and eliminates visible donor-site scarring.” They advocate for early surgical management in similar congenital deformities to optimize long-term mobility and psychosocial outcomes.