Syndactylization, toes (eg, webbing or Kelikian type procedure)
CPT4 code
Name of the Procedure
Syndactylization, toes (e.g., webbing or Kelikian type procedure)
Summary
Syndactylization is a surgical procedure to treat conditions where toes are partially or completely fused together. This may include webbing or involve the Kelikian type approach, where soft tissue and skin grafts are used to create a more natural appearance of separated toes.
Purpose
Syndactylization addresses congenital or acquired toe webbing or fusion. The goals are to improve the cosmetic appearance, enhance foot function, and alleviate any associated discomfort or mobility issues.
Indications
- Congenital syndactyly (fused toes present at birth)
- Acquired syndactyly (resulting from injury or trauma)
- Functional impairments causing difficulty in walking or wearing shoes
- Aesthetic concerns causing psychological distress
Preparation
- Preoperative consultation to discuss goals and expectations
- Fasting for at least 6-8 hours prior to surgery
- Adjustments to current medications as instructed by the healthcare provider
- Preoperative imaging or assessments such as X-rays or CT scans to plan the surgery
Procedure Description
- The patient is administered local or general anesthesia based on the complexity of the procedure.
- An incision is made along the fused area of the toes.
- Soft tissues are carefully separated, and excess skin is removed or repositioned.
- Skin grafts may be used to cover any exposed areas.
- The surgical site is sutured and dressed.
Tools: Scalpel, retractors, skin grafting instruments
Anesthesia: Local or general anesthesia
Duration
Typically, the procedure lasts between 1-3 hours.
Setting
The procedure is performed in a hospital or an outpatient surgical center.
Personnel
- Surgeon (typically an orthopedic or plastic surgeon)
- Surgical nurses
- Anesthesiologist (if general anesthesia is used)
- Operating room technicians
Risks and Complications
- Infection at the surgical site
- Poor wound healing or scarring
- Allergic reaction to anesthesia
- Recurrence of webbing or abnormal scar formation
- Reduced mobility or function of the toes
Benefits
- Aesthetic improvement with a more natural toe appearance
- Enhanced foot function and comfort in wearing shoes
- Increased self-esteem and psychological well-being
Benefits might be realized within a few weeks to a few months post-procedure, as healing progresses.
Recovery
- Keep the foot elevated and limit activity for the first few days
- Follow-up appointments for wound inspection and suture removal
- Instructions may include wearing a protective boot or cast
- Full recovery is expected within 4-6 weeks, though some restrictions may apply for up to 3 months
Alternatives
- Conservative treatments such as orthopedic footwear or physical therapy (less effective for permanent correction)
- Non-surgical cosmetic procedures (limited in their ability to address functional issues)
Pros: Less invasive
Cons: Less effective in providing lasting results compared to surgical method
Patient Experience
- The patient may experience mild to moderate discomfort post-procedure, manageable with prescribed pain medications.
- Swelling and bruising at the surgical site are common.
- Gradual improvement in toe function and appearance can be expected over the weeks following surgery.
- Regular follow-up visits ensure proper healing and manage any complications.
Pain management may include medication, ice applications, and keeping the foot elevated.