Saturday, July 28, 2012

Symbrachydactyly Web Deepening

Web space deepening is a straightforward surgical technique to provide a deeper space between fingers.  There are several variations of the technique of web space deepening, typically based on the number of skin flaps that are utilized.  These techniques include 2- flap, 4- flap, 5- flap and other variants; precision is required for all.  A variety of congenital anomalies may be surgically addressed with a web space deepening, including a small thumb (hypoplastic thumb) and certain types of syndactyly.

Symbrachydactyly (short, webbed fingers) may present in a variety of different ways.  I have provided some basic information about symbrachydactyly in a previous blog, http://congenitalhand.wustl.edu/search/label/Symbrachydactyly , and one treatment technique- lengthening- in another blog, http://congenitalhand.wustl.edu/2012/06/finger-lengthening.html .

What follows is a description of how a web space deepening can be helpful in symbrachydactyly.  In the first case, the short finger type, function is very limited.  Surgery will not restore normal or even near normal function but our goals should be limited.  Because the opposite hand is almost always normal, the goals for surgery on the affected hand in symbrachydactyly are limited.  If we can even slightly improve function, we can make the hand a better helper hand.  We can help the hand hold bigger objects.  In this case, we used a dorsal flap to resurface the web space between the thumb and the index finger.
Symbrachydactyly, short finger type, after surgery to deepen web space between thumb and index finger.

The second case is more unusual.  This is an example of the cleft type of symbrachydactyly.  This condition is different from a true cleft hand (central deficiency) which is discussed in previous postings:   http://congenitalhand.wustl.edu/2012/05/cleft-hand-surgery.html  and
http://congenitalhand.wustl.edu/2012/01/central-deficiency.html .  In this case, the patient and family complained about his inability to grasp large objects between the thumb and other digits.  After a discussion of the options, the family wanted to deepen the cleft.  While this might make the hand difference more apparent to others (i.e., make it more of a cosmetic issue), both the family and me felt that the functional improvement was worth this risk.
Symbrachydactyly, cleft type before surgery.

Symbrachydactyly, cleft type, after surgery from palm side

Symbrachydactyly, cleft type, after surgery from top of hand


Other treatment techniques for symbrachydactyly must be considered on a patient-by- patient basis.

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