Congenital Hand Disorders


Chapter 14

Congenital Hand Disorders





Radial Deficiencies



1. Deficiencies can range from mild thumb hypoplasia to complete absence of the radius.


2. All forms of radial deficiency warrant systemic evaluation for syndromes or associations (see Table 14.3).



3. Hypoplastic thumb


Occurs most commonly as part of radial deficiency


Blauth classification (see Table 14.4)


Correlates with degree of deficiency and necessary treatment



Treatment


The main determinant for thumb reconstruction and/or pollicization is the presence (Type IIIA) or absence (Type IIIB) of a stable carpometacarpal (CMC) joint.


Type-IIIA thumb: The child incorporates thumb into routine use.


Reconstruction is warranted


Great toe to thumb transfer is an excellent option when most of the metacarpal is present.


Type-IIIB thumb: Thumb is ignored by child and grasp actions occur between fingers.


Pollicization is the procedure of choice.


Movement of the metacarpal and neurovascular (NV) pedicle for a finger


Also indicated for Type-IV and -V thumbs


Options to release/deepen the web space


4-flap Z (4Z) plasty (see Figure 14.1)



5 Z (5Z) plasty or “jumping man” flap (see Figure 14.2)




Sep 2, 2016 | Posted by in Aesthetic plastic surgery | Comments Off on Congenital Hand Disorders

Full access? Get Clinical Tree

Get Clinical Tree app for offline access