Treatment of Cleft Hand using Snow-Littler Procedure

Tark, Kwan Chul; Kim, Young Seok; Jafarov, Murad

Abstract

The variation of cleft hand deformity is so wide that there are many synonyms and classifications for it. Among them the classification of Manske based on the condition of first web space is mostly important in functional perspectives. In type IIb or III of the Manske's classification, in which the thumb web space is narrowed or syndactylized, release and re-creation of the thumb web space is extremely important for functional and aesthetic reconstruction. A representative procedure for correction of the type IIb or III cleft hand is Snow-Littler procedure in which the cleft is released as a palmar-based flap and then transferred to the released first web space for creation of the commissure. During the last 10 years, the authors experienced 38 cases of cleft hand deformity in 30 patients. Among them type IIb or III cleft hand was 5 cases in 4 patients. In all patients, 3rd digit was missing except 1 case and the first web spaces were completely syndactylized. We applied the Snow-Littler procedure for correction of these 5 cases. The functional outcomes and patients' satisfaction were followed up postoperatively. Thumb abduction was possible in range of 59.6 +/- 12.3 degrees. Intermetacarpal stabilities were well maintained and average pinch power was 2.3 +/- 0.8 Kg. In one case partial necrosis of the palmar-based flap tip was occurred. Careful design and preservation of the intrinsic blood supply of the palmar-based flap is extremely important for viability of the flap and successful results.