Extra fingers, toes may need surgery
NINE-year old Belinda hates school because her playmates call her octopus. She has an extra finger on each hand and an extra toe on each foot, 24 digits in all.
By Irene Nabusoba
NINE-year old Belinda hates school because her playmates call her octopus. She has an extra finger on each hand and an extra toe on each foot, 24 digits in all.
Her father, Yusuf Melelengi says the feature runs in the family. “I have an extra finger on each hand.â€
Mulelengi has two other children who have extra digits - one with 23 and the other 22.
“In our family, if a child has no extra digit, it is not ours,†he says proudly.
Dr. Robert Ssentongo, head of plastic surgery at Mulago Hospital terms the condition as an extra numeral digit. He says this is abnormal because human beings have only four fingers and one thumb. A finger has three segments and a thumb has two.
“Anybody should be able to tell at birth and the condition should be dealt with as soon as it is recognised. However, it may prove difficult if the baby is born with five digits but with no thumb or when the digits look so alike,†Ssentongo says.
Extra infant appendages are often no more than little tags of boneless flesh. One may have it on the thumb, on a small finger or in between normal fingers (though rarely).
Doctors remove them by tying a tight knot around them to restrict the flow of blood. Without a blood supply, they wither and fall off.
But some come closely attached to the bone with all the three segments. They are more fully developed. X-rays show they have bones. The extra toes are even attached to the normal ones. Ssentongo says that makes removing them more complicated.
How should it be done? Surgery depends on how far it resembles the normal finger. If there is a bone in the extra digits, X-rays should be done. In some instances, it is still difficult to decide which digit should be removed and close observation of the function of the hands and feet as they develop, can give the answer.
“I prefer that parents seek medical advice. Some people have mastered the art of tying them at home with thread. Others resort to traditional healers. I do not recommend these approaches.
“With a case like Belinda’s, you will only be inflicting pain on the child. It will not fall off since it is attached to the bone. Traditional healers insist and manually cut it off. This can be disastrous. You may bleed to death or suffer related infections from the procedure,†Ssentongo cautions.
Determining which of the digits is abnormal is one of the most difficult tasks. One may remove the normal finger or toe hence affecting the functionality of the hand or foot, becoming very weak or completely stiff.
“The procedure should be professionally handled bearing in mind hygiene and functionality of the finger after the operation. We ensure that we do not jeopardise the functionality outcome,†he adds.
How common is this condition?
Ssentongo says whenever they go for surgery camps outside Kampala, about one out of 10 consultations are people with extra digits.
“Kampala midwives are probably more aware of the problem and deal with the cases before the babies are discharged,†he says.
An Internet site on health, www.medicinnet.com says Polydactylism is probably the most common abnormality of development at birth.
“Polydactylism is reported in about 2 per 1000 children. However, many of the simpler cases are taken care of in the nursery by the obstetrician or pediatrician and don't show up in these statistics.
“The most common form of polydactyly is a small, soft, extra finger that contains no bone. Many of these can be easily treated at birth by the attending physician who ties a suture tightly around the base. The extra digit falls off, and the normal appearing hand or foot heals quickly,†the site says.
When is the right time to seek medical attention?
The site says complex polydactyly is usually not repaired until a child is one year old. Generally, the digit that is best aligned with the long bones is saved. When the other digit is removed, sometimes transferring tendons from the amputated digit will make the one that remains more normal.
Sometimes a joint needs to be reconstructed, or a bony prominence shaved. If the case is complex, an orthopedic or plastic surgeon with expertise in hands and feet is preferred. Usually the results are excellent. But the surgery can usually be performed during the infant’s first year with few problems.
What is the cause of extra fingers and toes?
Heather Young, a pediatrician at Providence Medical Group’s Medford Pediatrics says that the trait is usually passed along in genes from one parent or the other.
“I just had a family where two of the girls were born with extra appendages,†she said.
“Such babies are likely to pass the gene on to any children they might have. If only one parent has the gene, a child would have a 50 percent chance of inheriting it.â€
She attributes the condition to irregularities during fetal development, or could also happen in connection with other diseases and disorders
Should the extra digits be removed anyway?
Physicians typically encourage parents to have extra fingers removed to avoid embarrassment.
“Parents have to think of whether the child would be teased a lot," says Young. “Each child wants to look like every other child.â€
“More fingers aren’t necessarily an advantage. If you have seven fingers it can be more difficult to use your hand.
“Extra fingers and toes, however, are relatively common and usually present no long-term problem.â€
Ends
NINE-year old Belinda hates school because her playmates call her octopus. She has an extra finger on each hand and an extra toe on each foot, 24 digits in all.
Her father, Yusuf Melelengi says the feature runs in the family. “I have an extra finger on each hand.â€
Mulelengi has two other children who have extra digits - one with 23 and the other 22.
“In our family, if a child has no extra digit, it is not ours,†he says proudly.
Dr. Robert Ssentongo, head of plastic surgery at Mulago Hospital terms the condition as an extra numeral digit. He says this is abnormal because human beings have only four fingers and one thumb. A finger has three segments and a thumb has two.
“Anybody should be able to tell at birth and the condition should be dealt with as soon as it is recognised. However, it may prove difficult if the baby is born with five digits but with no thumb or when the digits look so alike,†Ssentongo says.
Extra infant appendages are often no more than little tags of boneless flesh. One may have it on the thumb, on a small finger or in between normal fingers (though rarely).
Doctors remove them by tying a tight knot around them to restrict the flow of blood. Without a blood supply, they wither and fall off.
But some come closely attached to the bone with all the three segments. They are more fully developed. X-rays show they have bones. The extra toes are even attached to the normal ones. Ssentongo says that makes removing them more complicated.
How should it be done? Surgery depends on how far it resembles the normal finger. If there is a bone in the extra digits, X-rays should be done. In some instances, it is still difficult to decide which digit should be removed and close observation of the function of the hands and feet as they develop, can give the answer.
“I prefer that parents seek medical advice. Some people have mastered the art of tying them at home with thread. Others resort to traditional healers. I do not recommend these approaches.
“With a case like Belinda’s, you will only be inflicting pain on the child. It will not fall off since it is attached to the bone. Traditional healers insist and manually cut it off. This can be disastrous. You may bleed to death or suffer related infections from the procedure,†Ssentongo cautions.
Determining which of the digits is abnormal is one of the most difficult tasks. One may remove the normal finger or toe hence affecting the functionality of the hand or foot, becoming very weak or completely stiff.
“The procedure should be professionally handled bearing in mind hygiene and functionality of the finger after the operation. We ensure that we do not jeopardise the functionality outcome,†he adds.
How common is this condition?
Ssentongo says whenever they go for surgery camps outside Kampala, about one out of 10 consultations are people with extra digits.
“Kampala midwives are probably more aware of the problem and deal with the cases before the babies are discharged,†he says.
An Internet site on health, www.medicinnet.com says Polydactylism is probably the most common abnormality of development at birth.
“Polydactylism is reported in about 2 per 1000 children. However, many of the simpler cases are taken care of in the nursery by the obstetrician or pediatrician and don't show up in these statistics.
“The most common form of polydactyly is a small, soft, extra finger that contains no bone. Many of these can be easily treated at birth by the attending physician who ties a suture tightly around the base. The extra digit falls off, and the normal appearing hand or foot heals quickly,†the site says.
When is the right time to seek medical attention?
The site says complex polydactyly is usually not repaired until a child is one year old. Generally, the digit that is best aligned with the long bones is saved. When the other digit is removed, sometimes transferring tendons from the amputated digit will make the one that remains more normal.
Sometimes a joint needs to be reconstructed, or a bony prominence shaved. If the case is complex, an orthopedic or plastic surgeon with expertise in hands and feet is preferred. Usually the results are excellent. But the surgery can usually be performed during the infant’s first year with few problems.
What is the cause of extra fingers and toes?
Heather Young, a pediatrician at Providence Medical Group’s Medford Pediatrics says that the trait is usually passed along in genes from one parent or the other.
“I just had a family where two of the girls were born with extra appendages,†she said.
“Such babies are likely to pass the gene on to any children they might have. If only one parent has the gene, a child would have a 50 percent chance of inheriting it.â€
She attributes the condition to irregularities during fetal development, or could also happen in connection with other diseases and disorders
Should the extra digits be removed anyway?
Physicians typically encourage parents to have extra fingers removed to avoid embarrassment.
“Parents have to think of whether the child would be teased a lot," says Young. “Each child wants to look like every other child.â€
“More fingers aren’t necessarily an advantage. If you have seven fingers it can be more difficult to use your hand.
“Extra fingers and toes, however, are relatively common and usually present no long-term problem.â€
Ends