Central Deficiency (cleft hand)

Cleft Hand Surgery

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


  1. It’s amazing how grown up he looks in these pictures. As a Hand Surgeon i hope he has a speedy recovering. The function of a cleft hand is mostly not restricted, but yet, improving the function is one of the goals when the thumb or first webspace is absent.

  2. This is my son Aiden. He is 9 years old now and has complete function both hands like and boy his age. He's an major athlete that plays baseball and football very well. He also very well liked by his peers and has a great life. Thank you Dr. Goldfarb!

    1. We just had a grandson who was born with a left clef hand. I wish I could talk to Aiden’s mother because her son who is doing so well.
      There is a support group for the families ?.
      In which hospital did you have the operation?

      Thank you very much.

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