Syndactyly of the hand is a congenital anomaly characterized by an abnormal connection between adjacent digits. Simple syndactyly, which involves a soft-tissue connection between digits, occurs with an approximate incidence of 2 to 3 per 10,000 live births and tends to happen in families. Mild simple syndactyly that does not interfere with function does not require treatment. However, simple syndactyly of any considerable degree warrants surgical reconstruction of the web space for improved function and appearance. In most instances, reconstruction for simple syndactyly can be delayed until the child is 18 months of age, but release of border digits should be performed within the first few months of life to prevent development of a progressive tethering deformity. Reconstruction of the commissure is the most technically challenging aspect of the procedure. A local dorsal flap is recommended for commissure reconstruction to avoid the use of skin graft within the web space and to recreate the normal dorsal-to-palmar commissure slope. Full-thickness skin grafting is almost always required to cover residual uncovered areas. Complex syndactyly, which involves fusion of adjacent phalanges or interposition of accessory bones, warrants special surgical consideration. Strict guidelines for surgical reconstruction of complex syndactyly do not exist, however, and treatment must be individualized. Following reconstruction, patients should be assessed periodically because late complications such as web creep can occur.