Reconstruction of Congenital Abnormalities of the Upper Extremities

Abstract

Congenital abnormalities of the upper extremities may be hereditary or acquired in utero. They may be unilateral or may affect both limbs with identical or different deformities. The abnormalities in 120 patients have been reviewed and classified into two main groups: those anomalies of the upper extremity only and those associated with some general systemic disturbance. In order to crystallize the reconstructive need, the sixty-one patients in the first group were classified on the basis of clinical and anatomical manifestations. The primary aim of reconstruction is to provide the basic functions of the limb, namely, good skin and sensation, the ability to place the hand in a strategically useful position, and satisfactory pinch and grasp. These basic needs should be provided with the least possible number of surgical procedures. The procedures employed were stabilization and bone support, phalangization of fused digits by shifting local and distant skin, transfer of digits to provide pinch and grasp, and muscle transfer to give motion to newly constructed parts. The specific procedures used in a few selected patients are described to illustrate the individual needs of each patient and to stress the complexities of these reconstructive procedures. Deformities of the radial component constituted the largest group of the anomalies of the forearm. The most severe type of this deformity required stabilization of the hand by a fibular graft and pollicization of the index finger to replace the absent thumb and provide prehension. Reconstruction of missing digits is one of the more difficult problenms and entails the transfer of skin pedicles and bone struts or the transplantation of one or more toes. Both methods have their limitations and neither has restored normal function to the deformed hand. Other abnormalities such as fused, webbed, or partially amputated digits, and supernumerary digits, require phalangization, local and distal skin transfer, and other procedures. The general affections were in a group of fifty-nine patients, in whom the deformity of the upper extremity was owing to a systemic disturbance or was associated with it. Some of these deformities were similar in configuration to the anomalies of the first group and required similar management. Because of the dynamic character of these deformities inherent in the process of growth, recurrences of the deformity may take place even after successful reconstruction, and therefore constant vigilance is required.