Background: Polydactyly is a heterogeneous congenital limb anomaly in children affecting the hand or foot. Surgical management aims to restore function, alignment, stability, and acceptable appearance, but outcomes may vary according to anatomical subtype and reconstructive complexity. This systematic review evaluated surgical outcomes and complications of pediatric hand and foot polydactyly.

Methods: PubMed, Scopus, Web of Science, Embase, and Google Scholar were searched for studies published from January 2010 through January 2026. Eligible studies included original clinical research involving children with congenital hand and/or foot polydactyly undergoing surgical treatment and reporting functional, aesthetic, or complication-related outcomes. Two reviewers independently extracted data and assessed methodological quality using design-appropriate tools. Due to substantial clinical and methodological heterogeneity, findings were synthesized narratively.

Results: The search identified 2,123 records. After duplicate removal and screening, 96 articles underwent full-text assessment, of which 84 were excluded. Twelve studies were included in the qualitative synthesis. Overall, surgical correction generally resulted in favorable functional and aesthetic outcomes. However, residual or recurrent deformity, malalignment, instability, stiffness, scar-related problems, wound complications, infection, pain, and neurovascular symptoms were reported. Some patients required secondary corrective surgery. Outcomes appeared to be influenced by anatomical subtype, reconstructive complexity, relative development of duplicated digits or rays, and surgical technique. Hand and foot procedures demonstrated distinct functional priorities, limiting direct comparison of outcomes.

Conclusions: Surgical treatment generally provides favorable outcomes in children with hand and foot polydactyly, but residual deformity and postoperative complications remain clinically relevant. An individualized, anatomy-based reconstructive strategy is preferable to a universal operative approach. Prospective multicenter studies with standardized outcome measures and long-term follow-up are needed.