Postaxial Type a Polydactyly of All Four Limbs: Surgical Management of a Rare Congenital Presentation – A Case Report and Literature Review

Abstract

Postaxial polydactyly type A is a relatively common congenital anomaly in certain populations, typically presenting as a small, soft-tissue digit attached to the ulnar or fibular side of the hand or foot. Whilst most cases are isolated and involve a single limb, the synchronous occurrence across all four extremities—both hands and both feet—is exceedingly rare. Reports describing such a presentation are notably scarce in the current literature. In this article, we present a unique case of bilateral postaxial type A polydactyly affecting both upper and lower limbs, with a focus on clinical presentation, ideal timing for surgical intervention, and technical considerations to achieve optimal aesthetic and functional outcomes. Methods: We report the case of a 10-month-old male with symmetrical postaxial type B polydactyly on all four extremities, treated with surgical excision under local anaesthesia using absorbable intradermal sutures. A systematic literature review was also conducted to contextualise this anomaly and current management strategies. Results: Surgical excision was performed without complications. At 1-month follow-up, the patient exhibited satisfactory aesthetic results, no neurovascular compromise, and proper scarring. A review of 57 studies confirms early surgical excision as the preferred approach in type B duplications, with no consensus regarding optimal timing in cases involving multiple limbs. Conclusion: Although postaxial type A polydactyly is commonly observed in the upper limbs, its presence in all four extremities is rare. Early outpatient excision ensures excellent cosmetic and functional outcomes, particularly when performed by trained paediatric surgeons or hand specialists. Accurate phenotypic classification is essential for guiding treatment and informing recurrence risk.