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Creation of an opposable small finger by muscle transfer
1Department of Orthopaedic Surgery, Loma Linda University Medical Center, Calif.
Insights
This case study details surgical interventions for congenital hand anomalies, including metacarpal synostosis and absent thumb. Procedures like syndactyly release and muscle transfer improved hand function in a young patient.
Area of Science:
- Orthopedic Surgery
- Pediatric Hand Surgery
- Congenital Hand Anomalies
Background:
- Congenital hand anomalies present unique challenges in pediatric care.
- Metacarpal synostosis and absent thumbs require complex reconstructive strategies.
Observation:
- A child presented with metacarpal synostosis (index, long, ring fingers), syndactyly of the small finger, and an absent thumb.
- Initial surgery at 7 months involved syndactyly release and skin grafting to create a new thumb from the small finger.
Findings:
- A subsequent muscle transfer at age 4 improved opposition and overall hand function.
- The reconstructive procedures demonstrated positive functional outcomes.
Implications:
- This surgical approach offers a viable option for specific complex congenital hand deformities.
- Consideration of these techniques is recommended for select pediatric patients with rare anomalies.
Abstract:
We present a case of a child born with metacarpal synostosis of the index, long, and ring fingers associated with a simple syndactyly of the small finger and an absent thumb. At age 7 months, a syndactyly release with skin grafting to the small finger was accomplished so that it became the new thumb. At age 4 years, one of the muscles on the radical border of the hand was transferred to the small finger to act as an opposition transfer. At follow-up, the transfer contracted well and the functional capability of the hand was improved. This operation will not often be used but should be considered for the occasional patient with congenital anomalies.