Improvement of Cosmesis in the Surgical Treatment of Cleft Hand

Baek, Goo Hyun; Chung, Moon Sang; Jung, Hong Geun

Abstract

Being a rare disease entity, there have been few references about the cleft hand in Korea. We evaluated the postoperative cosmetic results of 17 cleft hands in 14 patients, who were treated surgically at the Department of Orthopedic Surgery of Seoul National University Hospital, from 1982 to 1993. Among 14 patients, 8 were males. Bilateral cleft hands were in five patients and unilateral in 9. Three of five patients who had bilateral cleft hands, were treated surgically on both hands. Remaining two patients had an operation on one hand which affected more severely. Average age at the time of operation was 2 years and 5 months(5 months-10years). Average duration of follow-up was 34 months(1 year 1 month-7years 5 months). By Lange's classification, typical patterns were 16 hands and atypical pattern one. By Flatt's classification, there were 8 hands of I b, 7 I c, 1 I a, 1 II. One patient had family history whose father had both cleft hands and feet. Congenital anomalies other than cleft hand were associated in 10 of 14 patients. Two patients had 3 associated anomalies, 4 patients 2, and 4 patients one. Syndactyly was the most common associated anomaly of affected cleft hand. Central cleft was closed by Snow-Littler technique in 4 hands(24%), Barsky method in 12(71%) and others in 1(6%). Metacarpal bone was treated by intermetacarpal ligament reconstruction in 1 hand(6%), excision only 7(41%), transfer of 2(rd) metacarpal to 3(rd) metacarpal base after excision 5(29%), and 2(rd) metacarpal corrective osteotomy 3(18%). Complications were in 2 hands; one wound dehiesence of cleft, and one partial necrosis of skin. The cosmetic results of surgical treatment were graded into good, fair or poor by the parents-Good ; when parents were satisfied with the result, Fair; improved cosmesis but not satisfied, and Poor; no improvement after surgery. Good was in 16 hands and fair in one.