Sunday, November 17, 2013

5- finger hand, follow- up



I have previously posted on the topic of the 5- finger hand.   This previous post summarized many of the key issues with this diagnosis.  http://congenitalhand.wustl.edu/2013/03/the-5-finger-hand.html

Here is the preoperative picture of one such child with a 5- finger hand.  Note the small extra thumb and the digits all aligned in the same plane.

5 finger hand with an extra thumb as well.  Note how difficult it is to sort out on which side the thumb resides.



There are 2 main problems with this situation: 1) The "thumb" is too long which can make pinching awkward and 2) the patient does not have a wide first web space which would allow the child to grasp large objects (soda can, etc).




Additionally, the child has to depend on a scissor- like pinch (side to side) rather than placing the "pulps" of the digits together to pinch.




We corrected this child's hand by:
1) removing small extra thumb
2) "pollicizing" the index finger.  See previous posts:
http://congenitalhand.wustl.edu/2011/10/pollicization-creating-new-thumb.html
http://congenitalhand.wustl.edu/2011/12/more-thoughts-on-pollicization-decision.html
http://congenitalhand.wustl.edu/2013/09/more-thoughts-on-pollicization.html
3) Shortening the new thumb.


5 finger hand after reconstruction including pollicization


In this case, there was a strong family history of the condition and the family is very pleased both with appearance and function.  The hand functions quite well with daily activities.





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