Abstract
Background:
The arms are commonly immobilized in a cast after syndactyly release. Despite this practice, there is little research examining complications from cast immobilization. This study compares the complication rates of congenital syndactyly release using casts and bulky soft dressings.
Methods:
A retrospective review was performed of patients undergoing syndactyly release. Patients were included if they underwent a primary release of congenital syndactyly and excluded if they had a noncongenital cause. Data regarding surgical procedures, medical complications, and unplanned caregiver phone calls and clinic/emergency department (ED) visits related to the dressings were recorded.
Results:
Ninety-five patients met inclusion criteria, representing 143 hands placed in casts and 25 in bulky dressings. No significant differences in surgical or medical complications were detected. The most common complications across all patients were web creep (10.1%), hypertrophic scarring (12.5%), and scar contracture (6.0%). Unplanned ED visits were noted in 1.4% of casts and 4.0% of bulky dressings and unplanned clinic visits were noted in 7.0% of casts and 8.0% of bulky dressings. Only 7.0% of casts and 8.0% of bulky dressings required replacement. Caregiver phone calls were seen for 14.0% of casted hands and 24.0% of bulky dressings. Regardless of dressing, hypertrophic scarring was more prevalent in non-White patients (22.9% versus 7.9%, P = 0.03), and web creep was more prevalent in male patients (14.4% versus 1.8%, P = 0.01).
Conclusions:
There is no significant difference in complications, phone calls, or unplanned clinic/ED visits between patients undergoing congenital syndactyly release placed in a cast or bulky soft dressings.
Takeaways
Question: For patients undergoing congenital syndactyly release, is there a difference in complication rates or unplanned medical encounters when hands are placed in a hard cast or bulky dressings postoperatively?
Findings: Using a retrospective cohort study, there was no significant difference in complication rates or unplanned medical encounters between hard casts and bulky dressings following syndactyly release.
Meaning: Both hard casts and bulky dressings may be safely used as postoperative dressings after syndactyly release.
INTRODUCTION
Syndactyly is a congenital hand difference in which adjacent digits do not fully separate via interdigital apoptosis during fetal development.1 Syndactyly of the hand affects 0.94 per 10,000 births2 and accounts for 20% of congenital hand malformations.1 It can occur as either an autosomal dominant mutation with incomplete penetrance and variable expressivity, as part of a congenital syndrome or sporadically.3 The extent of syndactyly can involve soft tissue only (simple) or bone (complex) and can be considered complete (extending to the fingertips) or incomplete (partial fusion of the fingers).3
Syndactyly release is typically performed at 1–2 years of age but can be performed earlier or later in life based on clinical circumstances or surgeon preference.4,5 Syndactyly release has minimal complication rates and revision surgery is needed in about 13% of cases.6 The most common complications include web creep, scar contracture, and hypertrophic scarring.7 Complication rates may vary by technique used. For example, using skin grafts has been shown to increase overall rates of contracture, web creep, and hypertrophic scarring.8 Patients who have previously undergone syndactyly release are known to have minor deficits in upper extremity function.9 Postoperative dressings typically include casts, splints, or bulky dressings, with the choice dependent on surgeon preference and judgement.1 When skin grafts are used, compression and immobilization are typically required for graft healing.10 In young children, plaster or fiberglass casts are routinely applied to prevent accidental dressing removal and to reinforce digit immobilization.3,11 Casts are effective at providing stability to an operative site as well as preventing wound disturbance in the pediatric population.
Although many surgeons prefer casts, one may elect to avoid application of a cast for pediatric extremity immobilization secondary to concerns regarding complications.12 These may include infection, pressure injury, and compartment syndrome13 leading to unplanned clinic visits, emergency department (ED) visits, or surgical emergencies.14–17 These unplanned visits and other problems specific to the dressing itself may contribute to higher caregiver burden and healthcare costs.18
In contrast to casts, bulky dressings may be used after pediatric hand surgery. These provide padding without the rigid support of either a cast or splint.19 Our experience and observations suggest that soft dressings are less commonly used than casts for syndactyly release. There is scant literature describing the differences in outcomes between the two types of dressings. The purpose of this study is to assess the differences in complication profiles between syndactyly releases dressed in casts and those dressed in bulky dressings. We hypothesize that there is no significant difference in medical or surgical complications, as well as no difference in the rate of unplanned medical encounters.
MATERIALS AND METHODS
A retrospective chart review was conducted on pediatric patients undergoing syndactyly release at a single institution between 2016 and 2024. Patients met inclusion criteria if they were 18 years of age or younger and underwent primary release for congenital syndactyly. Patients were excluded if they had noncongenital syndactyly (eg, trauma or burns), underwent secondary syndactyly release, or did not follow up after surgery. Data collection included patient demographics and operative details, such as dressing type following surgery (cast versus bulky dressing) and web space(s) released. Each hand was analyzed as an independent observation, with bilateral cases additionally analyzed as clustered events. Dressing type was determined by surgeon preference and clinical judgement. The data in this study reflect the operative experience of three pediatric hand surgeons. Complications such as dehiscence, infection, flap necrosis, web creep, scar contracture, flexion contracture, angulation deformity, hypertrophic scarring, compartment syndrome, pressure injuries, contact dermatitis, and joint stiffness were recorded. Details regarding follow-up were also noted and categorized, including the number of dressing changes, ED visits after surgery, parent phone calls related to the patient’s dressing or wound, and unplanned clinic visits.
For postoperative dressing technique, full thickness skin grafts were dressed using xeroform with or without antibiotic ointment, followed by gauze. Fiberglass long-arm casts were applied in all instances of casting in this study. Bulky dressings consisted of sterile gauze, cotton cast padding and medipore tape. Postoperative immobilization protocols did not differ beyond dressing type.
Statistical analyses were performed with R Statistical Software (v4.1.2; R Core Team 2021). Patients’ demographic and clinical characteristics were summarized using frequencies and percentages for categorical variables and medians and interquartile ranges for continuous variables. Cluster analysis by individual patient encounter was performed using a generalized estimating equation for complication rates, parent phone calls, and ED/clinic visits by dressing and syndactyly type. The Fisher exact test was used to assess any differences in demographic characteristics, complication rates, parent phone calls, and ED/clinic visits by cast type, as appropriate. The Mann-Whitney U test was used for any continuous variables. A P value less than 0.05 was considered significant.
RESULTS
Demographics
A total of 95 patients met inclusion criteria, representing 168 hands that underwent primary syndactyly release; 143 hands (85.1%) were placed in casts postoperatively and 25 (14.9%) received bulky dressings only. (See table, Supplemental Digital Content 1, which displays the demographics of the patient cohort undergoing primary syndactyly release, https://links.lww.com/PRSGO/F197.) The median age at the time of surgery was 1.19 years (interquartile range [IQR] 0.90–1.87 y). The median follow-up period was 153 days (IQR 46–608 d). Most hands belonged to patients who were male (66.1%), White (75.0%), and non-Hispanic (85.7%). Demographics did not vary significantly between the two groups. Full-thickness skin graft use was significantly higher in patients who received casts (P = 0.002).
Surgical Complications
No significant differences in complication rates were found between cast versus bulky dressing groups (Table 1). The most common complications across all hands were hypertrophic scarring (21 of 168, 12.5%), web creep (17 of 168, 10.1%), and scar contracture (10 of 168, 6.0%). Nineteen (13.3%) hands with casts experienced hypertrophic scarring compared to 2 (8.0%) hands with bulky dressings (P = 0.74). Web creep was observed in 13 (19.1%) hands with casts versus 4 (16.0%) hands with bulky dressings (P = 0.29). Scar contracture was recorded in 7 (4.9%) hands with casts and 3 (12.0%) hands with bulky dressings (P = 0.17). In bilateral procedures, the total complication rate did not differ between the dressing groups (P = 1.00). Multivariable analysis controlling for graft use, number of webspaces released, age at surgery, and syndactyly complexity yielded no variation in outcomes for all complications.
Table 1.
Medical and Surgical Complications of Patients Undergoing Primary Syndactyly Release by Dressing Type
| Cast (n = 143) | Bulky Dressing (n = 25) | Total (n = 168) | P | ||||
|---|---|---|---|---|---|---|---|
| Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | ||
| Dehiscence | 1 (0.7) | 142 (99.3) | 0 | 25 (100) | 1 (0.6) | 167 (99.4) | 1.00 |
| Infection | 3 (2.1) | 140 (97.9) | 1 (4.0) | 24 (96.0) | 4 (2.4) | 164 (97.6) | 0.48 |
| Flap necrosis | 0 | 143 (100) | 0 | 25 (100) | 0 | 168 (100) | 1.00 |
| Web creep | 13 (9.1) | 130 (90.9) | 4 (16.0) | 21 (84.0) | 17 (10.1) | 151 (89.9) | 0.29 |
| Scar contracture | 7 (4.9) | 136 (95.1) | 3 (12.0) | 22 (88.0) | 10 (6.0) | 158 (94.0) | 0.17 |
| Flexion contracture (n = 165) | 3 (2.1) | 39 (97.9) | 0 | 23 (100) | 3 (1.8) | 162 (98.2) | 1.00 |
| Angulation deformity (n = 167) | 2 (1.4) | 140 (98.6) | 0 | 23 (100) | 2 (1.2) | 165 (98.8) | 1.00 |
| Hypertrophic scarring | 19 (13.3) | 124 (86.7) | 2 (8.0) | 23 (92.0) | 21 (12.5) | 147 (87.5) | 0.74 |
| Compartment syndrome | 0 | 143 (100) | 0 | 25 (100) | 0 | 168 (100) | 1.00 |
| Pressure injuries | 0 | 143 (100) | 0 | 25 (100) | 0 | 168 (100) | 1.00 |
| Contact dermatitis | 2 (1.4) | 141 (98.6) | 0 | 25 (100) | 2 (1.2) | 166 (98.8) | 1.00 |
| Joint stiffness | 3 (2.1) | 140 (97.9) | 0 | 25 (100) | 3 (1.8) | 165 (98.2) | 1.00 |
When stratified by syndactyly type, there were no significant differences in complication rates between hands with simple, complex, or a mix of simple and complex syndactyly (treated as three groups) (Table 2). There were 109 hands with simple syndactyly, 50 hands with complex syndactyly, and 7 hands with mixed syndactyly types. Syndactyly subtype was undefined in 2 cases. Web creep was seen in 11 (10.1%) hands with simple syndactyly, 5 (10.0%) hands with complex syndactyly, and 1 (14.3%) patient with mixed syndactyly types (P = 0.81). Hypertrophic scarring was seen in 11 (10.1%) hands with simple syndactyly, 6 (12.0%) hands with complex syndactyly, and 2 (28.6%) hands with mixed syndactyly (P = 0.27). Scar contracture was seen in 6 (5.5%) hands with simple syndactyly, 4 (8.0%) of hands with complex syndactyly, and 0 hands with mixed syndactyly (P = 0.82).
Table 2.
Medical and Surgical Complications of Patients Undergoing Primary Syndactyly Release in Simple versus Complex Syndactyly
| Simple Syndactyly (n = 109) |
Complex Syndactyly (n = 50) | Mixed Simple and Complex Syndactyly (n = 7) | Total (n = 166) | P | |||||
|---|---|---|---|---|---|---|---|---|---|
| Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | ||
| Dehiscence | 0 | 109 (100.0) | 1 (2.0) | 49 (98.0) | 0 | 7 (100.0) | 1 (0.6) | 165 (99.4) | 0.34 |
| Infection | 1 (0.9) | 108 (99.1) | 2 (4.0) | 48 (96.0) | 1 (14.3) | 6 (85.7) | 4 (2.4) | 162 (97.6) | 0.51 |
| Flap necrosis | 0 | 109 (100.0) | 0 | 50 (100.0) | 0 | 7 (100.0) | 0 | 166 (100.0) | 1.00 |
| Web creep | 11 (10.1) | 98 (89.9) | 5 (10.0) | 45 (90.0) | 1 (14.3) | 6 (85.7) | 17 (10.2) | 149 (89.8) | 0.81 |
| Scar contracture | 6 (5.5) | 103 (94.5) | 4 (8.0) | 46 (94.0) | 0 | 7 (100.0) | 10 (6.0) | 156 (94.0) | 0.82 |
| Flexion contracture | 1 (0.9) | 108 (99.1) | 1 (2.0) | 49 (98.0) | 0 | 7 (100.0) | 2 (1.2) | 164 (98.8) | 0.57 |
| Angulation deformity | 0 | 109 (100.0) | 2 (4.0) | 48 (96.0) | 0 | 7 (100.0) | 2 (1.2) | 164 (98.8) | 0.17 |
| Hypertrophic scarring | 11 (10.1) | 98 (89.9) | 6 (12.0) | 44 (88.0) | 2 (28.6) | 5 (71.4) | 19 (11.4) | 147 (888.6) | 0.27 |
| Compartment syndrome | 0 | 109 (100.0) | 0 | 50 (100.0) | 0 | 7 (100.0) | 0 | 166 (100.0) | 1.00 |
| Pressure injuries | 0 | 109 (100.0) | 0 | 50 (100.0) | 0 | 7 (100.0) | 0 | 166 (100.0) | 1.00 |
| Contact dermatitis | 1 (0.9) | 108 (99.1) | 1 (2.0) | 49 (98.0) | 0 | 7 (100.0) | 2 (1.2) | 164 (98.8) | 0.57 |
| Joint stiffness | 2 (1.8) | 107 (98.2) | 1 (2.0) | 49 (98.0) | 0 | 7 (100.0) | 3 (1.8) | 163 (98.2) | 1.0 |
There were no significant differences in outcomes when comparing hands with complete or incomplete syndactyly or a mix of complete and incomplete syndactyly (treated as three groups) (Table 3). There were 84 hands with complete syndactyly, 71 hands with incomplete syndactyly, and 8 hands with a mix of complete and incomplete syndactyly (Table 3). Syndactyly subtype was undefined in 5 cases. Web creep was seen in 11 (13.1%) hands with complete syndactyly, 5 (7.0%) hands with incomplete syndactyly, and 1 (12.5%) patient with mixed syndactyly types (P = 0.39). Hypertrophic scarring was seen in 8 (9.5%) hands with complete syndactyly, 7 (9.9%) hands with incomplete syndactyly, and 3 (37.5%) hands with mixed syndactyly (P = 0.10). Scar contracture was seen in 7 (8.3%) hands with complete syndactyly, 2 (2.8%) hands with incomplete syndactyly, and 0 hands with mixed syndactyly (P = 0.32).
Table 3.
Medical and Surgical Complications of Patients Undergoing Primary Syndactyly Release in Complete versus Incomplete Syndactyly
| Complete Syndactyly (n = 84) |
Incomplete Syndactyly (n = 71) | Mixed Complete and Incomplete Syndactyly (n = 8) | Total (n = 163) | P | |||||
|---|---|---|---|---|---|---|---|---|---|
| Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | ||
| Dehiscence | 1 (1.2) | 83 (98.8) | 0 | 71 (100.0) | 0 | 8 (100.0) | 1 (0.6) | 162 (99.4) | 1.00 |
| Infection | 1 (1.2) | 83 (98.8) | 2 (2.8) | 69 (97.2) | 1 (12.5) | 7 (87.5) | 4 (2.5) | 159 (97.5) | 0.15 |
| Flap necrosis | 0 | 84 (100.0) | 0 | 71 (100.0) | 0 | 8 (100.0) | 0 | 163 (100.0) | 1.00 |
| Web creep | 11 (13.1) | 73 (86.9) | 5 (7.0) | 66 (93.0) | 1 (12.5) | 7 (87.5) | 16 (9.8) | 147 (90.2) | 0.39 |
| Scar contracture | 7 (8.3) | 77 (91.7) | 2 (2.8) | 69 (97.2) | 0 | 8 (100.0) | 9 (5.5) | 154 (94.5) | 0.32 |
| Flexion contracture | 2 (2.4) | 82 (97.6) | 0 | 71 (100.0) | 0 | 8 (100.0) | 2 (1.2) | 161 (98.8) | 0.55 |
| Angulation deformity | 1 (1.2) | 83 (98.8) | 0 | 71 (100.0) | 0 | 8 (100.0) | 1 (0.6) | 162 (99.4) | 1.00 |
| Hypertrophic scarring | 8 (9.5) | 76 (90.5) | 7 (9.9) | 64 (90.1) | 3 (37.5) | 5 (62.5) | 17 (10.4) | 1 (89.6) | 0.10 |
| Compartment syndrome | 0 | 84 (100.0) | 0 | 71 (100.0) | 0 | 8 (100.0) | 0 | 163 (100.0) | 1.00 |
| Pressure injuries | 0 | 84 (100.0) | 0 | 71 (100.0) | 0 | 8 (100.0) | 0 | 163 (100.0) | 1.00 |
| Contact dermatitis | 1 (1.2) | 83 (98.8) | 0 | 71 (100.0) | 1 (12.5) | 7 (87.5) | 2 (1.2) | 161 (98.8) | 0.10 |
| Joint stiffness | 1 (1.2) | 83 (98.8) | 2 (2.8) | 69 (97.2) | 0 | 8 (100.0) | 3 (1.8) | 160 (98.2) | 0.65 |
Further evaluation was conducted based on demographics. Independent of dressing type, hypertrophic scarring was more prevalent in non-White hands (22.9% versus 7.9%, P = 0.03), and web creep was more prevalent in male hands (14.4% versus 1.8%, P = 0.01).
Unplanned Medical Encounters
Postoperatively, we identified the following unplanned medical encounters: clinic visits (12 of 168, 7.2%), ED visits (3 of 168, 1.8%) (Table 4), and caregiver phone calls (24 of 168, 14.3%). Three (2.1%) patients treated with casts visited the ED for loose casts, whereas no patients in the bulky dressing group visited the ED (P = 1.00). Unplanned clinic visits occurred in 10 (7.0%) patients with casts and 2 (8.0%) patients with bulky dressings. Although most patients had no dressing-related caregiver phone calls, 19 (13.3%) caregivers in the cast group called in once, and 1 (0.7%) called twice; 5 (20.0%) caregivers in the bulky dressing group called once, and 1 (4.0%) called twice (P = 0.15). Unplanned replacement occurred for 7.0% of casts and 8.0% of bulky dressings (P = 0.69). In bilateral procedures, the total rate of unplanned medical encounters did not differ between the dressing groups (P = 0.69). Multivariable analysis controlling for graft use, number of webspaces released, age at surgery and syndactyly complexity yielded no variation in outcomes for all unplanned medical encounters.
Table 4.
Unplanned Encounters by Dressing Type
| Cast (n = 143) | Bulky Dressing (n = 25) | Total (n = 168) | P | ||||
|---|---|---|---|---|---|---|---|
| Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | ||
| Unplanned ED visits | 2 (1.4) | 141 (98.6) | 1 (4.0) | 24 (96.0) | 3 (1.8) | 165 (98.2) | 0.39 |
| Unplanned clinic visits | 10 (7.0) | 133 (93.0) | 2 (8.0) | 23 (92.0) | 12 (7.1) | 156 (92.9) | 0.69 |
| Unplanned dressing changes | 10 (7.0) | 133 (93.0) | 2 (8.0) | 23 (92.0) | 12 (7.1) | 156 (92.9) | 0.69 |
| 1 (%) | 2 (%) | 1 (%) | 2 (%) | 1 (%) | 2 (%) | ||
| No. caregiver phone calls | 19 (13.3) | 1 (0.7) | 5 (20.0) | 1 (4.0) | 24 (14.3) | 2 (1.2) | 0.15 |
No significant differences were seen in unplanned encounters between hands with simple and complex syndactyly (Table 5). A significant difference in the number of unplanned dressing changes was seen in hands with mixed complete and incomplete syndactyly (Table 6). Unplanned dressing changes occurred in 8 (9.5%) hands with complete syndactyly, 2 (2.8%) hands with incomplete syndactyly and 2 (25.0%) hands with a mix of complete and incomplete syndactyly (P = 0.04).
Table 5.
Unplanned Encounters in Simple versus Complex Syndactyly
| Simple Syndactyly (n = 109) |
Complex Syndactyly (n = 50) | Mixed Simple and Complex Syndactyly (n = 7) | Total (n = 166) | P | |||||
|---|---|---|---|---|---|---|---|---|---|
| Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | ||
| Unplanned ED visits | 0 | 109 (100.0) | 2 (4.0) | 48 (96.0) | 1 (14.3) | 6 (85.7) | 3 (1.8) | 163 (98.2) | 0.16 |
| Unplanned clinic visits | 6 (5.5) | 103 (94.5) | 5 (10.0) | 45 (90.0) | 1 (14.3) | 6 (85.7) | 12 (7.2) | 154 (92.3) | 0.25 |
| Unplanned dressing changes | 6 (5.5) | 103 (94.5) | 5 (10.0) | 45 (90.0) | 1 (14.3) | 6 (85.7) | 12 (7.2) | 154 (92.3) | 0.25 |
| 1 (%) | 2 (%) | 1 (%) | 2 (%) | 1 (%) | 2 (%) | 1 (%) | 2 (%) | ||
| No. caregiver phone calls | 15 (13.4) | 2 (1.8) | 7 (14.0) | 0 | 2 (28.6) | 0 | 24 (14.5) | 2 (1.2) | 1.00 |
Table 6.
Unplanned Encounters in Complete versus Incomplete Syndactyly
| Complete Syndactyly (n = 84) |
Incomplete Syndactyly (n = 71) | Mixed Complete and Incomplete Syndactyly (n = 8) | Total, n = 163 | P | |||||
|---|---|---|---|---|---|---|---|---|---|
| Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | Yes (%) | No (%) | ||
| Unplanned ED visits | 1 (1.2) | 83 (98.8) | 1 (1.4) | 70 (98.6) | 1 (12.5) | 7 (87.5) | 2 (1.2) | 161 (98.8) | 0.14 |
| Unplanned clinic visits | 7 (8.3) | 77 (91.7) | 3 (4.2) | 68 (95.6) | 2 (25.0) | 6 (75.0) | 9 (5.5) | 154 (94.5) | 0.09 |
| Unplanned dressing changes | 8 (9.5) | 76 (90.5) | 2 (2.8) | 69 (97.2) | 2 (25.0) | 6 (75.0) | 9 (5.5) | 154 (94.5) | 0.04 |
| 1 (%) | 2 (%) | 1 (%) | 2 (%) | 1 (%) | 2 (%) | 1 (%) | 2 (%) | ||
| No. caregiver phone calls | 12 (14.3) | 2 (2.4) | 9 (12.3) | 0 | 3 (37.5) | 0 | 24 (14.5) | 2 (1.2) | 0.61 |
DISCUSSION
Although syndactyly release is a common procedure in pediatric hand surgery, the complication rates between different postoperative dressing types are not well-known. Our findings indicate that there are no significant differences in complications after surgery for primary congenital syndactyly between those placed in a postoperative cast or bulky dressing. Furthermore, there are similar rates of unplanned caregiver phone calls, emergency visits, and unscheduled clinic visits across both groups.
To our knowledge, this is the first study to compare the postoperative outcomes for patients undergoing primary congenital syndactyly release. There is an ongoing debate as to whether patients undergoing soft tissue hand surgery require rigid immobilization in the immediate postoperative period.12,20–22 We have only identified anecdotal evidence to suggest that soft dressings do not lead to severe complications.23
In our cohort, hypertrophic scarring was significantly more prevalent in non-White patients and in male patients. Both findings corroborate previous studies.24–27 There is a small cohort of a patients with multiple types of syndactyly released on the same hand in the same procedure who had a significantly higher incidence of unplanned patient encounters and dressing changes; however, these differences were not related to the dressings used. Overall, there are no differences in surgical complications or in unplanned healthcare utilization from either casts or bulky dressings. Further work in the perioperative setting is required to prevent unnecessary healthcare utilization.
Other investigators have reported that casting in the pediatric population leads to unnecessary healthcare costs in the form of unplanned ED visits, leading to cast changes at rates of 5.3%18 and unplanned clinic visits in about 10% of patients.16 Additionally, studies report that casts involving the upper extremity in pediatric patients with fractures result in frequent ED visits for cast-related issues,14,15 as well as burdensome clinic visits.17 Although we did not specifically examine the financial aspects of unplanned medical encounters, one may assume that these encounters would substantially increase overall costs of care. These cost-related concerns, however, may not be relevant in congenital syndactyly cases, especially if there is no difference in the need for clinic or ED visits for early dressing removal in either cohort.
Limitations
Our study is limited by the lower proportion of hands placed in bulky dressings (15%), which may impact the detection of meaningful differences in uncommon complications between the two groups. Additionally, the retrospective design of this study may have introduced variability in the application of postoperative dressings. The inclusion of patients from multiple surgeons using different postoperative practices is beneficial for grouping data but may introduce bias. Surgeon preference of dressing type may have impacted our findings, as one surgeon in our study strictly placed bulky dressings and one strictly placed hard casts. Despite these limitations, our data is likely broadly applicable for pediatric hand surgeons treating congenital syndactyly.
CONCLUSIONS
In our study, the dressing type does not appear to be a primary determinant of complications and does not significantly affect the rates of unplanned medical encounters. Given these findings, further work should be done to investigate the true value of routine postoperative casting after congenital syndactyly reconstruction.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
Supplementary Material
Footnotes
Published online 1 September 2026.
Presented at The Pediatric Hand Study Group Annual Meeting.
Disclosure statements are at the end of this article, following the correspondence information.
Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com.
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