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 |
