Congenital Hand Differences
There are several common hand differences present in newborns, including syndactyly (webbed fingers), polydactyly (accessory digits), digital contracture (camptodactyly and clinodactyly), trigger fingers, short fingers (brachydactyly) and large fingers (macrodactyly).
If left untreated, these conditions will usually interfere with the development and function of the hand as the child grows. At our reconstructive plastic surgery practice in Melbourne, Dr. David Ross can advise on the benefits of surgical intervention for congenital hand differences at an early age to allow the hand to look and function as normally as possible in the future.
The timing of congenital hand surgery procedures can vary depending on the severity of the deformity and the development of the child. Dr. Ross can advise you when these procedures are best undertaken in a preoperative consultation.
Syndactyly (Webbed digits) – Treatment
Syndactyly is a congenital condition where two or more fingers fuse together as a result of bone and/or tissue failing to separate in the womb. Simple syndactyly involves fusion of the soft tissue elements of the digit only, whereas complex syndactyly involves fusion of the bones as well. Surgical correction of syndactyly is usually advised within the first year of life. As multiple fingers can be involved, often several procedures are required to achieve improved hand function. In the surgical procedure the digital elements are separated, releasing the webbed tissue between the fingers – usually skin graft from the groin area is required to achieve wound closure. Where bones have fused in the hand, more complex hand surgery may be required to achieve improved hand appearance and function.
Polydactyly (Accessory digits) – Treatment
Polydactyly is a condition characterised by extra digits on the hand. There can be several variations in the structure of accessory digits, each requiring a different type of treatment. In most cases, polydactyly can be definitively corrected by a plastic surgery procedure. Accessory digits are most commonly seen adjacent to the little finger (preaxial polydactyly) or the thumb (postaxial polydactyly), but other variations are possible. Surgery can often correct these anomalies completely, but in some situations multiple procedures will be required to achieve the best functional and aesthetic outcome. Dr. Ross will be able to advise which treatment modalities may be possible following his assessment of the child’s hand.
Please contact Bayside Plastic Surgery in Victoria to schedule a consultation with Dr. David Ross about the surgical treatment of polydactyly.
Brachydactyly (Shortened digits) – Treatment
Brachydactyly is a congenital condition where some or all of the digits are shortened or underdeveloped. This situation can result in underdevelopment of the thumb only or all the fingers in the hand can be affected. This was the limb deformity originally seen in thalidomide children but there are a number of other conditions that result in this deformity, including Poland’s Syndrome, radial club hand, Holt-Oram syndrome and others. Reconstructive plastic surgery procedures are aimed at optimizing hand function by improving digit length and mobility. This can be achieved by bone lengthening (distraction osteogenesis), digit transfer usually from the foot or in the case of underdeveloped thumb, transfer of the index finger to create a thumb (pollicization). Pollicization of the index finger to reconstruct an absent or underdeveloped thumb is a highly technical procedure and should only be undertaken by a paediatric plastic surgeon, with considerable reconstructive hand surgery experience
These surgical procedures are quite complex and involve extensive consultation and planning prior to instigation. Please contact Dr. Ross at Bayside Plastic Surgery in Melbourne to discuss these conditions in further length.
Macrodactyly (Overgrown digits) – Treatment
Macrodactyly is a rare condition where one or more of the digits are overgrown. Although it may be present at birth it can also occur in older patients as a result of abnormal soft tissue growth in the digit. Surgical correction of this condition is difficult and may require multiple surgical procedures to achieve an improved functional digit if the overgrowth involves the soft tissues only. If there is evidence of skeletal overgrowth, surgery is unlikely to be beneficial and amputation of the digit may be advisable. Dr. Ross can advise on the treatment options for this condition.
Camptodactyly/Clinodactyly (bent digits) – Treatment
Camptodactyly and clinodactyly are two congenital conditions causing bent fingers that are not passively correctible. Although not always, commonly these conditions are related to birth syndromes, for example camptodactyly is commonly found in children with Down’s Syndrome. Camptodactyly usually refers to a forward contracture of the proximal interphalangeal joint of the little or ring fingers, whereas clinodactyly usually refers to a lateral deviation of the little finger at the same joint toward the ring finger. Clinodactyly is often directly inherited and can become manifest at birth or in the teenage years, particularly in females.
Initial treatment is only required if the contracture is significant (30° plus) and causing a functional problem and involves splinting to straighten the digit. Surgery is only recommended for more severe contractures or those resistant to splinting, but may not be successful as scarring can cause a recurrent deformity. Dr Ross can advise the benefits of treatment following an initial assessment.
Clasped Thumb Deformity (Thumb contracture) – Treatment
Contracture of the thumb noticed soon after birth is the most common congenital deformity of the hand. The parents usually notice that the child cannot move the thumb to grasp or grip and when they attempt to straighten the digit notice that it is locked in flexion. On occasions it can be a number of years before the condition is recognised but it is usually present at birth. The condition is usually due to impediment of the tendon that allows the thumb to move. Correction of this problem requires a short surgical procedure to release the tendon sheath over the tendon in the base of the thumb. Dr. Ross will be able to assess this problem in consultation and advise on a treatment plan to correct this condition.
To find out more about the treatment of syndactyly, polydactyly, digital contractures, microtia, vascular anomalies, congenital naevi, cleft lip, cleft palate, and more, please contact the plastic surgery practice of Dr David Ross in Melbourne, Victoria today.