[Surgical treatment of congenital malformations of the hand]

The commoner and more important congenital deformities of the hand are reviewed, considering their clinical picture, indications and optimal age for intervention, operative technique, postoperative care, and results. It is stressed that the value of many of the procedures can be assessed only after several years, and often only at the end of the growing period. The following malformations are discussed: 1. Syndactyly: There are many patterns of deformity; fusion of fingers of unequal legnth and distal bony fusion with convergence are absolute indications for early separation (six months of age); in uncomplicated cases operation can wait until the second year of life. Correctly placed skin incisions are of great importance for the prevention of scar contractures; a zig-zag incision forms long triangular flaps for cover of the sides of the fingers, splitting up areas of full-thickness skin graft; the commissure is formed from either two triangular flaps or a single dorsal rectangular flap...