Congenital hand deformities may be as simple as a child born with an extra digit or trigger finger to clefting of the hand and simple and complex syndactylies.
For syndactylies, simple or complex, the most important aspect of the operation is to define the proper webspace after separating the fused fingers. This requires detailed understanding of the anatomy and surgical technique. In order to create the webspace, a portion of the dorsal skin at the newly created webspace is used as a flap to define this webspace. The remaining skin flaps on both sides are carefully elevated and closed as much as possible without too much tension. In almost all instances, skin grafting is required to resurface skin in those areas adjacent to the webspace that can not be closed directly by adjacent skin. If skin grafts are not used, this will usually compromise the creation of the webspace and recurrence of syndacytyly or fused fingers could occur. A good donor site to obtain skin graft is to shave skin from the plantar instep of the foot. The skin on the foot will heal back normally. The color match to the reconstructed fingers is excellent. Another good location to obtain a skin graft is from the lower abdomen if the foot is not used.
Traumatic hand deformities range from injuries caused by table saw, car accidents, sharp knives or blunt trauma. Although immediate surgical treatment may lead to normal function, oftentimes residual deficits are significant and require secondary reconstruction.
Surgical techniques and timing for each kind of congenital and traumatic hand deformity are important. Over my 14 years in practice, I have performed hundreds of operations for congenital hand anomalies and traumatic hand injuries. My approach is to give a comprehensive assessment of the hand deformity, obtain proper radiographic information to understand the problem entirely and give an honest opinion about what is possible to correct the problem. This requires a comprehensive understanding of hand and wrist anatomy and precise reconstructive procedures to correct the vast array of hand problems.