[Differential therapeutic Approaches in congenital Malformations of the Hand]

With the same clinical picture, different pathological changes must be expected in congenital malformations of the hand. Therefore, knowledge of these pathologies is crucial for planning the surgical approach. The approaches to common malformations are dealt with as examples. These include the double thumb and the syndactyly.In the case of the double thumb with an asymmetrical contour, the result is improved by augmenting parts of the redundant double thumb. In this case, a different incision is required than in simple resection.In the frequently performed syndactyly separations, there are many techniques that have been proven to achieve a good result. But only if principles such as local displacement flap plasty for commissure formation, tension-free wound closure, no longitudinal incisions and no bilateral preparation of a finger are observed here too. If it can be assumed preoperatively that a good surgical result cannot be achieved with the conventional technique of syndactyly separation, pre-treatment using an external fixator for transverse soft tissue distraction is the method of choice.The timing of surgery takes into account not to disturb the motor development of the affected person.