Cleft hand (Central Deficiency) reconstruction is a challenging surgical procedure. This child’s hand demonstrates some of the difficulties. There are 3 problems in the hand. First, the space between the thumb and the index finger is narrowed which limits his ability to grasp large objects. Despite his young age (2 years), mom and dad have noticed this difficulty. Second, the obvious central cleft related to a complete absence of the long finger (middle finger) and its metacarpal bone. He may use this cleft for function to make up for the thumb limitations but clearly not an ideal way to function. Finally, there is ring/ small finger syndactyly (actually a partial syndactyly).
We address all three issues when we surgically reconstruct this hand:
1) Rearrange the soft tissues of the thumb- index web space. We use what is called a 4- flap z- plasty to deepen and improve the contour of the web space.
2) Cleft reconstruction in this case involves removal of extra skin between the fingers and tightening the space between the index finger and ring finger. We use part of the tendon sheath of the two fingers to stabilize these 2 fingers in a more aligned, narrowed posture.
3) Partial syndactyly. We utilized a dorsal flap to recreate the commissure between the fingers and then re- arranged the skin around this flap.
This reconstruction is difficult primarily because we are attempting to provide a better functioning and better appearing hand without the usual guiding landmarks to assist us. Because none of the web spaces are normal, the judgment on how to best align the new web spaces is challenging. The photographs below show before and after surgery.
|Cleft hand before surgery
|Cleft hand from palm view before surgery
|Cleft hand with small space between thumb and index finger
|Cleft hand immediately after surgery
|Cleft hand after surgery
|Cleft hand after surgery, palm view