There may be a times, thankfully not often, when improving function may come at a cost of some worsening of appearance. If this is a possibility, frank discussions should be held with the family and many will eagerly proceed with an intervention for improved function.
This case is one example. The child has symbrachydactyly, the cleft type (classification is reviewed in this POST). He does well overall but has trouble grasping with the hand.
|Symbrachydactyly, cleft type, palm view|
|Symbrachydactyly, cleft type, top view|
|Symbrachydactyly, cleft type, top view with thumb held|
|This is the same patient after cleft deepening.|
|Palm view after cleft deepening.|
For this particular patient, the seemingly small amount of deepening will (and has) make a notable difference for function. And as he gets older, lengthening the bones can still be considered.
My Bio at Washington University