Skip to main content
SpringerLink
Log in

New techniques in the operative treatment of congenital malformations of the hand and forearm

Neue Techniken der operativen Behandlung angeborener Fehlbildungen der Hand und des Unterarmes

  • Main Topics: Current Strategies Of Hand Surgery — Part 1
  • Published:
European Surgery Aims and scope Submit manuscript

Summary

Background: The rapid development of hand surgery in general has influenced the treatment of congenital malformations of the hand and forearm.

Methods: The current indications and techniques for reconstruction of congenital malformations of the hand and forearm are reviewed.

Results: Of the new techniques in the operative treatment of congenital malformations of the hand and forearm, the microsurgical procedures have to be mentioned first. The use of vascularized transplantation of toe and toe joints to thumb and fingers as well as the treatment methods for proximal radioulnar synostosis and congenital forearm pseudarthrosis have special indications. The different procedures of callus distraction, distraction transposition, and transverse soft-tissue distraction facilitating the separation of narrow syndactylies have to be known. Syndactyly separation without skin grafts must be discussed critically.

Conclusions: Congenital malformations of the hand and forearm are rare. Knowledge of the optimal corrective techniques and experience are mandatory to improve functional long-term results.

Zusammenfassung

Grundlagen: Die rasche Entwicklung der Handchirurgie hat auch die Behandlung angeborener Fehlbildungen der Hand und des Unterarms beeinflußt.

Methodik: Die aktuellen Indikationen und Techniken zur Rekonstruktion angeborener Defekte der Hand und des Unterarms werden als Übersicht zusammengefaßt.

Ergebnisse: Unter den neuen Techniken zur operativen Behandlung angeborener Fehlbildungen der Hand und des Unterarms nehmen mikrochirurgische Verfahren eine wichtige Stellung ein. Zehen- und Gelenktransplantationen zum Ersatz oder zur Verbesserung von Daumen- und Fingerfunktion, Verfahren zur Behandlung proximaler radioulnarer Synostosen und angeborener Pseudarthrosen von Radius und Ulna haben bestimmte Indikationen. Die Kenntnis der Methoden zur Kallus-Distraktion, zur Transposition von vorher distrahierten Händen und die quergerichtete Weichteildistraktion vor der Trennung einer engen Syndaktylie ist besonders wichtig. Eine Syndaktylietrennung ohne Einfügen von Vollhauttransplantaten ist kritisch zu beurteilen.

Schlußfolgerungen: Angeborene Fehlbildungen der Hand und des Unterarms sind selten. Die Kenntnis der optimalen Technik zu ihrer Korrektur und Erfahrung bilden die Grundlage zur Verbesserung der funktionellen Langzeitergebnisse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allieu Y, Gomis R, Yoshimura M, Dimeglio A, Bonnel F: Congenital pseuddarthroses of the forearm — two cases treated by free vascularized fibular graft. J Hand Surg 1981;6:475–481.

    CAS  Google Scholar 

  2. Aronson J: Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. J Bone Joint Surg 1997;79A:1243–1258.

    Google Scholar 

  3. Bellew M, Kay SP: Psychological aspects of toe to hand transfer in children. J Hand Surg 1999;24B:712–718.

    Google Scholar 

  4. Ben Youssef K: Les transferts d’orteil chez l’enfant, These. Tunis, 1986.

  5. Bradbury E, Kay SPJ, Hewison J: The psychological impact of microvascular free toe transfer for children and their parents. J Hand Surg 1994;19B:689–695.

    Google Scholar 

  6. Bradbury E: Psychological Issues for children and their parents. In: Buck-Gramcko D (ed.): Congenital Malformations of the Hand and Forearm. London, Churchill Livingstone, 1998, pp 49–56.

    Google Scholar 

  7. Buck-Gramcko D: Pollizisation des Zeigefingers bei Aplasie des Daumens. Handchirurgie 1971;3:45–59.

    PubMed  CAS  Google Scholar 

  8. Buck-Gramcko D: Pollicization of the index finger. J Bone Joint Surg 1971;53A:1605–1617.

    Google Scholar 

  9. Buck-Gramcko D: Angeborene Fehlbildungen der Hand. In: Nigst H, Buck-Gramcko D, Millesi H (Hrsg.): Handchirurgie, Band I. Stuttgart, Thieme, 1981, pp 12.1–12.115. (English translation, 1988)

    Google Scholar 

  10. Buck-Gramcko D: Microsurgery in congenital malformations of the hand. In: Brunelli G (ed.): Textbook of Microsurgery. Milano, Masson, 1988, pp 933–940.

    Google Scholar 

  11. Buck-Gramcko D: Pollicization. In: Buck-Gramcko D (ed.): Congenital Malformations of the Hand and Forearm. London, Churchill Livingstone, 1998, pp 379–402.

    Google Scholar 

  12. Buck-Gramcko D: Radialization for radial club hand. Techniques in Hand and Upper Extremity Surgery 1999;3:2–12.

    PubMed  CAS  Google Scholar 

  13. Buck-Gramcko D: Discussion to Bader B, Grill F: Die Ulnaverlängerung beim Osteochondrom (multiple kortilaginäre Exostosen) am Unterarm. Handchir Mikrochir Plast Chir 2000;32:328–332.

    Article  PubMed  CAS  Google Scholar 

  14. Buck-Gramcko D: Congenital anomalies of the wrist. In: Watson HK, Weinzweig J (eds): The Wrist. Philadelphia, Lippincott Williams & Wilkins, 2000, pp 123–148.

    Google Scholar 

  15. Buck-Gramcko D: Congenital disorders: radial and ulnar club hand. In: Berger RA, Weiss A-PC (eds): Hand Surgery. Philadelphia, Lippincott Williams & Wilkins, 2002, in press.

    Google Scholar 

  16. Buck-Gramcko U, Buck-Gramcko D: Die freie Zehentransplantation bei angeborenen Handfehlbildungen. Handchir Mikrochir Plast Chir 1995;27:181–188.

    PubMed  CAS  Google Scholar 

  17. Cooney WP, Wood MB: Microvascular reconstruction of congenital anomalies and post-traumatic lesions in children. Hand Clin 1992;8:131–146.

    PubMed  Google Scholar 

  18. Dahl MT: Upper-extremity lengthening. In: Gupta A, Kay SPJ, Scheker LP (eds): The Growing Hand. London, Mosby, 2000, pp 1049–1056.

    Google Scholar 

  19. Debeer P, De Smet L, van de Ven WZM, Fabry G, Fryns J-P: Genes and orthopedics: from gene to clinic and vice versa. Acta Orthop Belg 2002;68:203–214.

    PubMed  Google Scholar 

  20. Ducloyer P, Saffar P: La maladie de Madelung. In: Gilbert A, Buck-Gramcko D, Lister G (eds): Les Malformations Congenitales du Membre Superieur. Monographes du Groupe d’Etude de la Main 18. Paris, Expansion Scientifique Franaise, 1991, pp 51–61.

    Google Scholar 

  21. Ekerot L: Syndactyly correction without skin-grafting. J Hand Surg 1996;21B:330–337.

    Google Scholar 

  22. Entin MA: Reconstruction of congenital aplasia of phalanges in the hand. Surg Clin N Am 1968;48:1165–1168.

    Google Scholar 

  23. Foucher G: Vascularized joint transfers. In: Green DP, Hotchkiss RN, Pederson WC (eds): Green’s Operative Hand Surgery. 4th edn. New York, Churchill Livingstone, 1999, pp 1251–1270.

    Google Scholar 

  24. Foucher G, Moss ALH: Microvascular second toe to finger transfer: a statistical analysis of 55 transfers. Br J Plast Surg 1991;44:87–90.

    Article  PubMed  CAS  Google Scholar 

  25. Fujimaki A, Yamauchi Y: Application of microsurgery to congenital anomalies of the hand. Seikeigeka (Orthopaedic Surgery) 1984;35:142–150.

    Google Scholar 

  26. Gilbert A: Reconstruction of congenital hand defects with microvascular toe transfers. Hand Clin 1985;1:351–360.

    PubMed  CAS  Google Scholar 

  27. Gilbert A: Toe transfers for congenital hand defects. J Hand Surg 1982;7:118–124.

    CAS  Google Scholar 

  28. Golash A, Watson JS: Nail fold creation in complete syndactyly using Buck-Gramcko pulp flaps. J Hand Surg 2000;25B:11–14.

    Google Scholar 

  29. Greuse M, Coessens BG: Congenital syndactyly: defatting facilitates closure without skin graft. J Hand Surg 2001;26A:589–594.

    Google Scholar 

  30. Gu Y-D, Zhang G-M, Cheng D-S, Yan J-G, Chen X-M: Free toe transfer for thumb and finger reconstruction in 300 cases. Plast Reconstr Surg 1993;91:693–700.

    PubMed  CAS  Google Scholar 

  31. Itoh Y, Arai K: A new operation for syndactyly and polysyndactyly of the foot without skin grafts. Br J Plast Surg 1995;48:306–311.

    Article  PubMed  CAS  Google Scholar 

  32. Kanaya F: Mobilization of congenital proximal radio-ulnar synostosis. A technical detail. Techniques in Hand and Upper Extremity Surgery 1997;1:183–188.

    PubMed  CAS  Google Scholar 

  33. Kanaya F: New approach to congenital radio-ulnar synostosis. In: Gupta A, Kay SPJ, Scheker LT (eds): The Growing Hand. London, Mosby, 2000, pp 237–241.

    Google Scholar 

  34. Kay SP, Wiberg M: Toe to hand transfer in children. Part 1: Technical aspects. J Hand Surg 1996; 21B:723–734.

    Google Scholar 

  35. Kay SP, Wiberg M, Bellew M, Webb F: Toe to hand transfer in children. Part 2: Functional and psychological aspects. J Hand Surg 1996;21B:735–745.

    Google Scholar 

  36. Kay SPJ: Microvascular toe transfer in children. Part A: The congenital defect. In: Gupta A, Kay SPJ, Scheker LR (eds): The Growing Hand. London, Mosby, 2000, pp 987–999.

    Google Scholar 

  37. Lister G: Microsurgical transfer of the second toe for congenital deficiency of the thumb. Plast Reconstr Surg 1988;82:658–665.

    PubMed  CAS  Google Scholar 

  38. Lister G, Scheker L: The role of microsurgery in the reconstruction of congenital deformities of the hand. Hand Clin 1985;1:431–442.

    PubMed  CAS  Google Scholar 

  39. Manske PR, McCarroll HR: Reconstruction of the congenitally deficient thumb. Hand Clin 1992;8:177–196.

    PubMed  CAS  Google Scholar 

  40. Mathoulin C, Gilbert A, Azze RG: Congenital pseudarthrosis of the forearm: treatment of six cases with vascularized fibular graft and a review of the literature. Microsurgery 1993;14:252–259.

    Article  PubMed  CAS  Google Scholar 

  41. Mattat R, Azze RJ, Resende MR: Congenital pseudarthrosis of the forearm. In: Gupta A, Kay SPJ, Scheker LR (eds): The Growing Hand. London, Mosby, 2000, pp 1035–1040.

    Google Scholar 

  42. May JW, Smith RJ, Peimer CA: Toe-to-hand free tissue transfer for thumb construction with multiple digit aplasia. Plast Reconstr Surg 1981;67:205–213.

    Article  PubMed  Google Scholar 

  43. Nanchahal J, Tonkin MA: Pre-operative distraction lengthening for radial longitudinal deficiency. J Hand Surg 1996;21B:103–107.

    Google Scholar 

  44. Niranjan NS, De Carpentier J: A new technique for the division of syndactyly. Eur J Plast Surg 1990;13:101–104.

    Article  Google Scholar 

  45. Nishijima N, Matsumoto T, Yamamuro T: Two-stage reconstruction for the hypoplastic thumb. J Hand Surg 1995;20A:415–419.

    Google Scholar 

  46. Nyárády J, Szekeres P, Vilmos Z: Toe-to-thumb transfer in congenital grade III thumb hypoplasia. J Hand Surg 1983;8:898–901.

    Google Scholar 

  47. O’Brien BM, Black MJM, Morrison WA, MacLeod AM: Microvascular great toe transfer for congenital absence of the thumb. Hand 1978;10:113–124.

    Article  PubMed  CAS  Google Scholar 

  48. O’Brien BM, Brennen MD, MacLeod AM: Microvascular free toe transfer. Clin Plast Surg 1978;5:223–237.

    PubMed  CAS  Google Scholar 

  49. Ogino T, Kato H, Ishii S, Usui M: Digital lengthening in congenital hand deformities. J Hand Surg 1994;19B:120–129.

    Google Scholar 

  50. Ono H, Tamai S, Yajim H, Mizumoto S, Inada Y: Vascularized toe joint transfer for floating thumb. J Jpn Soc Surg Hand 1991;3:510–514.

    Google Scholar 

  51. Ostrowski DM, Eilert RE, Waldstein G: Congenital pseudarthrosis of the ulna: a report of two cases and a review of the literature. J Pediatr Orthop 1985;5:463–467.

    PubMed  CAS  Google Scholar 

  52. Paley D, Herzenberg JE: Distraction treatment of the forearm. In: Bock-Gramcko D (ed): Congenital Malformation of the Hand and Forearm. London, Churchill Livingstone, 1998, pp 73–117.

    Google Scholar 

  53. Rayner CR: Microsurgery in the treatment of congenital hand deformities. In: Meyer VE, Black MJM (eds): Microsurgical Procedures. The Hand and Upper Limb. Vol 7. Edinburgh, Churchill Livingstone, 1991, pp 240–253.

    Google Scholar 

  54. Schneider W, Reichert B, Pallua N, Meyer H: Freie mikrochirurgische Metatarsaletransplantation zur Korrektur einer Daumenhypoplasie. Handchir Mikrochir Plast Chir 1994;26:120–125.

    PubMed  CAS  Google Scholar 

  55. Seitz WH: Distraction treatment of the hand. In: Buck-Gramcko D (ed.): Congenital Malformation of the Hand and Forearm. London, Churchill Livingstone, 1998, pp 119–128.

    Google Scholar 

  56. Sherif MM: V-Y dorsal-metacarpal flap: A new technique for the correction of syndactyly without skin graft. Plast Reconstr Surg 1998;101:1861–1866.

    Article  PubMed  CAS  Google Scholar 

  57. Shibata M: Metatarsophalangeal joint transfer for type III-B hypoplastic thumb. In: Gupta A, Kay SPJ, Scheker LR (eds): The Growing Hand. London, Mosby, 2000, pp 183–188.

    Google Scholar 

  58. Shibata M: Symphalangism. In: Gupta A, Kay SPJ, Scheker LR (eds): The Growing Hand. London, Mosby, 2000, pp 289–292.

    Google Scholar 

  59. Smith AA, Greene T: Preliminary soft tissue distraction in congenital forearm deficiency. J Hand Surg 1995;20A:420–424.

    Google Scholar 

  60. Špokevičius S, Radzevičius D: Late toe-to-hand transfer for the reconstruction of the congenital defects of the long fingers. Scand J Plast Reconstr Hand Surg 1997;31:345–350.

    Article  Google Scholar 

  61. Tajima T: Reconstruction of the floating thumb. In: Buck-Gramcko D (ed.): Congenital Malformations of the Hand and Forearm. London, Churchill Livingstone, 1998, pp 369–373.

    Google Scholar 

  62. Taylor GI, Miller GDH, Ham FY: The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975;55:533–544.

    PubMed  CAS  Google Scholar 

  63. Tsai T-M, Lim B-H, Zhang G-M: Vascularized joint transfer. In: Gupta A, Kay SPJ, Scheker LR (eds): The Growing Hand. London, Mosby, 2000, pp 1009–1019.

    Google Scholar 

  64. Vickers D, Donnelly W: Corrective surgery of syndactyly without the use of skin grafts. Hand Surg 1996;1:203–209.

    Article  Google Scholar 

  65. Vickers D, Nielsen G: Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg 1992;17B:401–407.

    Google Scholar 

  66. Vilkki SK: Distraction and microvascular epiphysis transfex for radial club hand. J Hand Surg 1998;23B:445–452.

    Google Scholar 

  67. Vilkki SK: Vascularized joint transfer for radial club hand. Techniques in Hand and Upper Extremity Surgery 1998;2:126–137.

    Article  PubMed  CAS  Google Scholar 

  68. Wood VE: Brachymetacarpia (short metacarpals). In: Green OP, Hotchkiss RN, Pederson WL (eds): Green’s Operative Hand Surgery. 4th edn. New York, Churchill Livingstone 1999, pp 390–396.

    Google Scholar 

  69. Yamauchi Y, Fujimaki A, Yanagihara Y, Yoshizaki K: Reconstruction of floating thumb — especially in the use of vascularised metatarsophalangeal joint grafting. Seikeigeka (Orthopaedic Surgery) 1979;30:1645–1648.

    Google Scholar 

  70. Zguricas J, Bakker WF, Heus H, Lindhout D, Heutink P, Hovil SER: Genetics of limb development and congenital hand malformations. Plast Reconstr Surg 1998;101:1126–1135.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Am Heesen 14 A, D-21033, Hamburg, Germany

    D. Buck-Gramcko M.D.

  2. Department of Hand Surgery, Kinderkrankenhaus Wilhelmstift Hamburg, Germany

    R. Habenicht

Authors
  1. D. Buck-Gramcko M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Habenicht
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buck-Gramcko, D., Habenicht, R. New techniques in the operative treatment of congenital malformations of the hand and forearm. Eur. Surg. 35, 129–136 (2003). https://doi.org/10.1046/j.1682-4016.2003.03035.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1682-4016.2003.03035.x

Keywords

Schlüsselwörter

Search

Navigation