Friday, December 12, 2014

Short Fingers- Treatment Choices

Symbrachydactyly means short and webbed fingers but the term really includes a wide range of presentations.  I have previously posted on symbrachydactyly a number of times and this Post summarizes the 7 different types of hand appearance.  I have also written that I prefer certain techniques to lengthen the fingers such as bone lengthening or web space deepening- read Here and Here .  However, I do believe that using toes to lengthen fingers might make sense in certain very specific situations.  Consider this child:

Symbrachydactyly with excellent thumb.

Symbrachydactyly with excellent thumb.

Radiographs of same child with symbrachydactyly showing the great thumb and limited other digits.

This patient has symbrachydactyly although it shares some similarities to hypodactyly, as defined by Ezaki, et al article.  This patient has a great thumb but limited finger development.  The hand and metacarpal bones are well developed but there simply is very little development of the fingers (phalanges).  And, importantly for this discussion, there are excellent soft tissue pouches that can be used for reconstruction.

In order to provide a strong pinch, we elected to reconstruct the index finger which was the most developed finger.  It had a small remnant of the proximal phalanx and a small fingernail (with some of the distal phalanx beneath it.  To me, this seems like the ideal candidate for a nonvascularized toe to hand transfer.  While there can be problems with the feet, typically patients do well.  And the index finger has immediate length and stability and, we all hope, will grow (as long as the growth plates of the transferred bone remain open).

Symbrachydactyly after free toe phalanx transfer.

Palmar view after surgery for free toe transfer in symbrachydactyly.

Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu

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