Complication Rates of Casts Versus Bulky Dressings After Syndactyly Release

Abstract

Introduction: Pediatric patients undergoing surgical correction of congenital syndactyly are commonly immobilized in rigid casts postoperatively. Postoperative casting is associated with complications including skin irritation/breakdown, pressure sores, and unplanned dressing changes. This study directly compares complication rates between patients undergoing congenital syndactyly release treated with postoperative casting and soft dressing. Methods: A retrospective chart review was performed of patients who underwent primary surgical release of congenital syndactyly at a single quaternary referral center between 2016 and 2024. Demographic data and postoperative complications (infection, web creep, scar contracture, hypertrophic scarring, etc.) were recorded and compared between patients who had postoperative casting and soft dressing. Results: Ninety-two patients met inclusion criteria, representing 151 hands in the cast group and 20 hands in soft dressing group. No significant differences were observed in complication rates between the two groups. The most common complications across all hands were web creep (9.9% vs.10.0%, casts vs. soft dressings, p=1), hypertrophic scarring (10.6% vs. 5.0%, p=0.697), and scar contracture (5.3% vs. 10.0%, p=0.330). Three casts required unplanned ED visits and 11 required unplanned clinic visits related to casts whereas no patients in the soft dressing group required ED or unplanned clinic visits (p=1 and p=0.366, respectively). Five casts (3.3%) required replacement. The number of parent phone calls and dressing changes were not significantly different between the two groups (p=0.976 and p=0.803, respectively). Conclusion: Utilizing rigid casts after syndactyly release is not associated with greater rates of postoperative complications compared to soft dressings. Casting has an increased risk of unplanned visits relating to cast management. Significance: This is the first study showing that postoperative casting and soft dressings for congenital syndactyly release have very similar complication profiles. The use of soft dressings may avoid the unplanned healthcare visits and costs associated with casting.