Congenital hand surgery: what's new and what's coming

The Impact of Microsurgery on Congenital Hand Anomalies Associated with Amniotic Band Syndrome

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Background:

Amniotic Band Syndrome is a clinical constellation of congenital anomalies characterized by constricting rings, tissue synechiae and amputation of body parts distal to the constriction bands. Involvement of the hand with loss of multiple digits not only leads to devastating deformities but also loss of functionality.

Methods:

In this series, utilizing microvascular transfer of the second toe from both feet, along with local tissue reconfiguration, a tetra-digital hand with simile of normal cascade was reconstructed. A consecutive series of eight children with Amniotic Band Syndrome, younger than two years in age operated on by single surgeon over a twenty five year interval was reviewed.

Results:

There was no flap loss. The hands were sensate with effective simple prehensile function.

Conclusion:

Application of Microvascular toe-to-hand transfer for well selected, albeit severe hand deformity in Amniotic Band Syndrome is a valid surgical concept.

Embryology, diagnosis, and evaluation of congenital hand anomalies

Although congenital hand anomalies are rare, musculoskeletal clinicians should have a basic understanding of their clinical manifestations and the possibility of concurrent anomalies and syndromes. In this review, we provide a brief overview of the embryology of limb development and the molecular pathways involved. We also summarize the clinical manifestations, diagnostic evaluation, and principles of surgical treatment for radial longitudinal deficiency, thumb hypoplasia, ulnar longitudinal deficiency, central deficiency, syndactyly, polydactyly, and amniotic constriction band. Although one of the main goals of treatment is to provide a functional upper extremity, musculoskeletal clinicians should be aware of the clinical findings that should trigger referral to evaluate for life-threatening syndromes.

Congenital hand surgery research and education: observations of the 2009-2010 Bunnell Traveling Fellow

Since its establishment in 1982, the Bunnell Traveling Fellowship has sponsored an annually selected member of the American Society for Surgery of the Hand to pursue an in-depth study of a topic germane to the interests of each honoree. My goal, as the 29th Traveling Fellow, was to visit selected sites around the world that have successfully integrated congenital hand research and education with outstanding care of affected children. The purpose of this report was to provide a brief description of my travels and the lessons I have learned regarding the research and teaching of congenital hand surgery.