Surgical treatment of type I and type IIA congenital cleft hands

Objective To investigate the surgical treatment of type Ⅰ and type ⅡA congenital cleft hands and the clinical outcomes.Methods Between July 2006 and July 2011,17 cases (in 14 patients) of type Ⅰ and type ⅡA congenital cleft hands were surgically treated.The transverse metacarpal ligament was reconstructed with A1 pulleys along with soft tissue plasty in the central V-shaped cleft.Widening of the first web space was done in 9 cases of type ⅡA deformity.Results The postoperative follow-up period ranged from 6 to 25 months,the mean length being (17.0 ± 4.2) months for all cases.All wounds healed by first intention.The gripping and pinching function were good.Normal flexion and extension were achieved in 16 cases,while 25°extension lag of the proximal interphalangeal joint of the ring finger was noticed in one case.One index finger showed mild radial deviation and rotation.Parents of all 14 patients were satisfied with the postoperative appearance.Conclusion Transverse metacarpal ligament reconstruction with A1 pulleys and soft tissue plasty at the central cleft can significantly improve the appearance and function of the hand in type Ⅰ and type ⅡA congenital cleft hands. Key words: Hand deformities, congenital;  Surgical procedures, operative;  Cleft hand