Extra Finger (Polydactyly) Surgery in Ankara, Turkey

Extra fingers (polydactyly) is the condition of having more fingers or toes than normal in the hand or foot. It is a congenital anomaly and is often seen with a genetic inheritance pattern. The degree of extra digit formation can vary from a simple skin appendage to fully developed fingers with joints.

Polydactyly usually appears on the thumb side, the little finger side, or in line with the fifth toe in the foot. It is divided into three main types: preaxial, postaxial, and central polydactyly. Each is associated with different genetic and developmental mechanisms.

Diagnosis is made at birth by physical examination, but in some cases it can also be detected with prenatal ultrasound. Before planning surgical intervention, the structure of the digit is evaluated with imaging methods such as X-rays. Genetic counseling may be required for differential diagnosis.

Treatment is determined according to the structure and functionality of the digit. Digits that cause functional problems or cosmetic discomfort are surgically removed. Intervention is usually performed at an early age, and physical therapy may be recommended afterward.

What Is Extra Finger (Polydactyly) Surgery?

Extra finger (polydactyly) surgery is the surgical correction of a congenital condition in which there are more fingers or toes than normal in the hand or foot. This operation is planned according to the structure of the extra digit and its connections to bone, tendons, or nerves. The aim is both to improve aesthetic appearance and to prevent functional losses. The surgery, typically performed during infancy, provides successful and permanent results with an appropriate surgical technique.

What is polydactyly, and why does it occur?

The developmental process in the womb is truly a miraculous journey. In the very early stages of pregnancy, that is, in the first weeks, your baby’s hands and feet are actually shaped like small “paddles” or “flippers.” The fingers have not yet separated. By around the 6th and 7th weeks of pregnancy, our genetic codes come into play and the cells between the fingers begin to disappear in a programmed manner. In this way, five separate fingers emerge from that fused structure. The condition we call polydactyly occurs when tissues behave a bit “generously” during this separation and shaping process. As the finger bud splits, it creates an extra copy.

This formation may sometimes present as just a small piece of skin, or it may appear as a fully developed finger with bone, nail, joint, and tendons. The question families are most curious about is, “why did this happen to us?” Most of the time, we cannot find a specific reason.

Some factors that may play a role in the development of this condition are:

• Genetic predisposition
• Environmental factors during pregnancy
• Medication use
• Radiation exposure
• Viral infections

However, I would like to emphasize again that in the vast majority of cases, it does not result from something the mother or father did or did not do; this is simply a feature of embryological development.

Is polydactyly a genetically inherited condition?

The answer to this question is both yes and no. We broadly divide polydactyly cases into two groups. The first group is what we call “sporadic,” meaning completely coincidental situations unique to that baby, with no prior occurrence in the family. The majority of cases I encounter in clinical practice fall into this group. There is no carrier status in the parents’ genetics, and the likelihood of it occurring in subsequent children is the same as in the general population.

The second group consists of familial inherited cases. If there is a history of extra fingers in the mother, father, or first-degree relatives, then we can talk about a genetic inheritance. In particular, extra digits seen symmetrically on both hands or both feet suggest a stronger genetic background.

Inheritance patterns that may be effective in familial cases are:

• Autosomal dominant inheritance
• Autosomal recessive inheritance
• X-linked inheritance

If there is such a history in the family, genetic counseling may be helpful. However, if your baby has an isolated extra digit on only one hand or foot, it is generally unnecessary to worry about a complex genetic syndrome. Most polydactyly cases are localized conditions seen in healthy, normally developing babies and involve only the hand or foot.

In which parts of the body is polydactyly seen?

Extra digits do not appear randomly in the hands and feet; they follow certain patterns of location. We surgeons plan treatment entirely according to this location, because the surgical difficulty and healing process differ from region to region.

Types of polydactyly seen in the hand are:

• Radial polydactyly
• Ulnar polydactyly
• Central polydactyly

Radial polydactyly refers to extra digits on the thumb side. This is the most critical area in hand surgery. The thumb is the most important worker of the hand; it plays the leading role in tasks such as holding, gripping, and writing. Therefore, an extra digit here is not only an aesthetic issue but also a very serious functional one. Ulnar polydactyly refers to extra digits on the little finger side. They are generally simpler in structure, and their surgical solutions are easier than those for the thumb. Central polydactyly is the rarest and most complex form, seen in the middle of the hand, involving the index, middle, or ring finger. It is often associated with syndactyly (webbed fingers) and requires highly detailed surgical planning.

What is done for the diagnosis of polydactyly before surgery?

When your baby is born, the visual examination tells us “there is an extra digit,” but it does not answer the question “what is inside.” For successful surgery, we must know the unseen part of the iceberg. Two digits that look identical from the outside can have very different bone structures on the inside.

The methods we use in the diagnostic process are:

• Physical examination
• Plain X-ray radiographs
• Motion analysis
• Assessment of the vascular structure

X-rays are our map. Where does the bone of the extra digit separate from? Do they share a joint with the main digit? Or does it have its own separate metacarpal bone? The answers to these questions determine our surgical strategy. We also observe how the baby uses the hand. Sometimes a digit that looks small and weak from the outside may actually have better-functioning tendons. When deciding which digit to remove and which to preserve, we look not only at X-rays but also at how the baby moves that digit. This detailed analysis is vital so that your child can use their hand in the most efficient way after surgery.

When should polydactyly surgery be performed?

This is the topic families ask about most often and perhaps the one they are most impatient about. I often hear the question, “Doctor, can’t we remove it tomorrow?” I understand this feeling very well; parents want their baby to achieve a “normal” appearance as soon as possible. However, medical realities advise us to be a bit patient.

Factors that determine the timing of surgery are:

• Anesthesia safety
• Anatomical size
• Motor development stages
• Psychological impact

Our general approach is to wait until the baby is 10–12 months old. In other words, around 1 year of age is ideal. The main reason is anesthesia safety. Gaining some weight and lung development in the baby minimize anesthesia risks. The second reason is anatomy. In a newborn, the vessels and nerves in the finger are so thin that it is very difficult to distinguish and protect them even under the microscope. Toward 1 year of age, these structures grow and our surgical success rate increases.

In addition, 1 year of age is when a child’s fine motor skills—namely the ability to grasp objects with the fingertips—begin to develop. If we correct the hand anatomically before the child acquires these skills, the brain codes the hand map correctly and the child learns to use the hand naturally as if they never had surgery. Completing this before school age also prevents the child from being exposed to peer bullying in social environments or being psychologically affected.

Is the ligation (tying off) method suitable for polydactyly?

I want to address this topic in particular because unfortunately we still encounter some misconceptions. Especially when small extra digits on the little finger side are attached only by a thin skin stalk, you may hear suggestions such as “let’s tie it off with a string; if blood doesn’t go to it, it will dry up and fall off.” As a physician, I will say clearly: Please do not do this.

The drawbacks of the ligation method are:

• Neuroma formation
• Risk of infection
• Poor wound healing
• Aesthetic defects
• Risk of bleeding

Inside that structure that appears to be just a piece of flesh from the outside, there is often, even if tiny, a nerve branch. When you tie it off and let the tissue necrose, that nerve end remains exposed and, during healing, forms a sensitive lump called a “neuroma,” which causes an electric-shock-like pain when touched. In addition, the remaining skin can look like a protruding nub and appears aesthetically poor. Surgical excision, on the other hand, is a controlled procedure. We ligate the vessel, cut the nerve and bury it into muscle so it does not cause pain, and we close the excess skin with aesthetic sutures. The result is both painless and smooth.

Why is thumb polydactyly surgery special?

Thumb duplication, namely radial polydactyly, is a condition where surgical planning is like playing chess. Because the thumb is the “captain” of the hand. It is the finger that enables us to grasp objects by opposing the other four fingers (opposition). When removing an extra digit here, we must consider stability as well as aesthetics.

The points we pay attention to in thumb surgery are:

• Joint stability
• Tendon balance
• Range of motion
• Bone alignment

We generally use a system called the Wassel classification. In the most common type we see, two thumbs arise from a single base. Usually, the outer thumb is less developed and we remove it. However, when we cut it away, an important ligament attached to that thumb (the collateral ligament) is also removed. If we do not repair this ligament, the remaining thumb may gradually deviate sideways, take on a “Z” shape, and the child may not be able to grasp objects strongly.

Therefore, during surgery, we carefully separate the ligaments on the digit we will remove like a “spare part” and transfer them to the joint of the main thumb that will remain. In this way, we obtain both a single thumb and a rock-solid joint. In some cases (the Bilhaut-Cloquet technique), both thumbs are weak. In that case, we combine the two half-thumbs in the middle to create a single, thicker thumb. This is a much more delicate technique.

Is foot polydactyly only an aesthetic problem?

Extra toes, especially those on the little-toe side, may sometimes be seen as a “good luck charm” by families and not be taken seriously. Since it can be hidden in socks in winter, there may be no rush. However, foot polydactyly can become a serious comfort problem when the child starts walking and wearing shoes.

Problems that foot polydactyly can cause are:

• Difficulty wearing shoes
• Painful calluses
• Ingrown toenails
• Gait disturbance
• Chronic pain

The forefoot (metatarsal region) becomes much wider than normal due to an extra toe and its metatarsal bone. Standard shoes feel tight on this foot. The child is forced to wear larger shoes, or the side of the shoe quickly deforms. The compressed toe develops constant pain and callus formation.

Our goal in foot surgery is to “narrow” the foot and bring it back to a normal width. While doing this, it is not enough to remove only the toe; we also need to correct the excess or prominence of the metatarsal bone inside. If that bony prominence is left behind, it can continue to cause pain years later as shoes keep rubbing against it. That is why foot surgeries require technical care at least as much as hand surgeries.

Will there be a scar after polydactyly surgery?

Every surgical procedure, by its nature, leaves a scar. Unfortunately, there is no such concept as “scarless surgery” in medicine; however, there are “hidden scars” or “subtle scars.” This is the biggest obsession of us plastic surgeons. In polydactyly surgeries, we never make straight incisions as if drawn with a ruler.

The techniques we use to hide scars are:

• Zigzag incisions
• Concealing within natural creases
• Z-plasty technique
• Aesthetic suture materials

Fingers are organs that constantly flex and extend. If you make a straight incision on the palmar side of the finger, that scar contracts as it heals and restricts finger movement (contracture). It can pull the finger backward and cause it to remain flexed. To prevent this, we design our incisions in zigzag patterns. This allows the scar to stretch as the finger moves. We also try to place sutures on the side surfaces of the finger—parts that are not visible from the front. With scar creams and massages used in the postoperative period, these scars fade over time, take on the color of the skin, and become unnoticeable unless closely inspected.

What is the recovery process like after polydactyly surgery?

The part families fear most is postoperative care. They worry that “the child won’t stay still, will open the bandage, and will be in a lot of pain.” However, it is proven by experience that children are much more resilient and compliant in healing than adults. The recovery process is much more comfortable than you might think.

Expected situations in the postoperative period are:

• Mild pain
• Use of a cast or splint
• Dressing follow-up
• Restricted movement

After surgery, your child’s hand or foot will be in a bulky bandage or a cast splint to both prevent swelling and protect bone healing. There may be mild pain on the first night, but this can be fully controlled with simple syrups. Children usually start playing the next day and continue their lives by using their other hand.

If we performed bone correction and there is a wire (K-wire) inside, this dressing stays for about 3–4 weeks. During this period, the only thing you need to do is keep the dressing dry. After 3–4 weeks, we remove the dressing in the clinic and pull out the wires. Wire removal takes seconds and usually does not require anesthesia and does not hurt. Afterward, we encourage the child to use the hand.