SURGICAL TREATMENT OF CONGENITAL CENTRAL DEFICIENCY OF THE HAND (CLEFT HAND) IN AN ADULT PATIENT - CASE REPORT

Abstract

Cleft hand is a congenital hand anomaly, which is characterized by the absence of one or more central digits (II, III and/or IV) of the hand and/or foot. The clinical appearance is very irregular, and treatment of cleft hand involves cosmetic and functional considerations. Due to the great clinical variability, the choice of the appropriate surgical procedure is difficult as there is no single surgical procedure to treat all cleft hands. We present a case of bilateral cleft hand in an adult male patient (24 years of age). The patient presented with cleft hand of both hands; the right hand more severely affected with missing middle metacarpal and finger, typical V cleft with wide interdigital space, normal first web space and incomplete syndactyly of IV-V finger. Since his main concern was the cosmetic appearance of the right hand and there was good function in the thumb and index finger, the logical choice was to close the central cleft and preserve the function he already had. Postoperatively, the patient gained useful grip with all fingers, a satisfactory range of motion and preserved useful pattern of pinch. The cosmetic appearance improved substantially, much to the patient’s satisfaction. To the best of our knowledge, this is the first reported case of cleft hand in our country. For an adult patient to whom the aspect of cosmetic appearance is very important, surgery is indicated for cosmetic improvement, but care must be taken not to sacrifice the functionality of the hand.