Sunday, January 22, 2012

Central Deficiency

Central deficiency is also called cleft hand.  It typically includes a missing long finger (middle finger) and a narrow thumb- index web space.  Severity varies and some patients have loss of additional digits or a syndactyly of the ring and small fingers.  Like many congenital anomalies, central deficiency is considered from both a functional and an appearance perspective.  The most important consideration for function is the space between the thumb and the index finger.  This space is reconstructed with the skin of the cleft if the narrowing is severe or, in a more mild narrowing, with a local skin rearrangement (z- plasty).  The cleft is a notable appearance issue.  Sometimes the cleft is reconstructed with a soft tissue reconstruction alone and other times, the index finger (actually the index ray) is moved away from the thumb to both widen the thumb- index web space and narrow the cleft.

Central deficiency with large cleft
Slight narrowing of first web space in central deficiency hand

The thumb- index web space is not terribly narrow so was reconstructed with a local skin rearrangement while the cleft was narrowed.
Corrected cleft in central deficiency

Another view of corrected cleft in central deficiency

Sunday, January 15, 2012

Recurrent Syndactyly

This 8 year old male was surgically treated with syndactyly reconstruction utilizing skin grafts 6 years ago (in his hometown).  He did well although the skin between the fingers gradually crept distally towards the fingertips.  The skin growth limited the spread of the fingers.

Creep of web space after syndactyly correction

He and his family requested surgical reconstruction.  Hoping to avoid the use of skin grafts, we utilized a "Box Flap" technique which provided a satisfactory outcome.  These photographs are pictures from the operating room.

Revision syndactyly correction

Palmar view of syndactyly revision correction

Tuesday, January 3, 2012

Toe Polydactyly

Toe Polydactyly

I am a congenital hand surgeon and, therefore, treat children with birth abnormalities of the upper extremity.  However, because abnormalities of the feet, including extra toes and toe syndactyly, are similar to hand anomalies, I also treat children with some birth differences of the feet. 

Toe polydactyly (extra toes) is less common and also less of a problem than extra fingers.  In some instances, extra toes can be ignored.  However, if the extra toes affect the width of the foot, wearing shoes can be a problem.  If shoe wear is difficult, removal of the extra toes is recommended to narrow the foot.

This case demonstrates a relatively minor extra toe next to the 3rd toe.  There is also a partial syndactyly between the great toe and the second toe.

Toe polydactyly

This child has a more significant extra great toe on each side preventing shoe wear.  

Severe manifestation of extra great toe

The other foot with great toe polydactyly

This was treated prior to standing/ walking and by 12 months of age, the child was able to wear shoes.

Scar after correction of polydactyly of great toe.

View of foot after correction of polydactyly

Other foot after polydactyly treatment.