The most common congenital defect of the hand is syndactyly. This is caused by incomplete separation of the fingers during limb development. In this article, we discuss the embryological basis, risk variables, and classification methods that guide surgical decision-making. The aim of reconstructive surgery is to produce a functional, aesthetic, and independent web space without any sequelae such as scar contracture or digital necrosis. We discuss indications for intervention, including timing of surgery according to the type of syndactyly and associated disorders. Current surgical techniques involve full-thickness skin grafts, dorsal advancement flaps, and a modified dorsal pentagonal flap.