Correction of the typical cleft hand

The correction of type II and III typical cleft hands can be complicated because each hand can contain a variation of congenital problems including syndactyly, camptodactyly, thumb hypoplasia, deficiency of the first web space, abnormal phalanges, maligned joints, and abnormal intrinsic muscles and extrinsic tendons. The most difficult problem is the index ray, which lies in a "no man's land" between the central cleft and the mobile thumb. Presented in this paper is a technique for correction and transposition of the index ray through a simple incision, which separates the glabrous from the dorsal skin surfaces. Skeletal alignment must be precise. Preservation of the adductor pollicis muscle, if present, is crucial to a functional pinch. Long-term problems such as persistent radial deviation of the index finger and unyielding flexion contractures can be avoided.