Surgical Procedure for the Cleft Hand: Especially in Relation to Restoration of Instinsic Muscle Function of the Shifted Index Finger*

Abstract

We have thirty‐eight patients of cleft hand, and they were divided into three groups from the surgical point. Four patients (seven hands) has only one digit on the radial side of the cleft. In these patients there was little indication for the surgical improvement. The thumb and index finger are completely webbed in six patients (seven hands), and reconstruction to permint thumb function is essential above all in these. In most patients of cleft hand (thirty‐one out of thirty‐eight) thumb function is preserved, but abduction of the thumb was more or less limited. Surgical procedure for these patients are discussed. There are three important point in surgical reconstruction of the celft hand; First is a skin incision to restore thumb abduction; Second is a realignment of the second metacarpal (index ray); and Third is a restoration of intrinsic function. Regarding the first and second point we reported previously (Miura and Komada, 1979). Now, we would like to emphasis that intrinsic function act as a key to get satisfactory result in surgical procedure for the cleft hand. We could use the extrinsic extensor or flexor muscles of the missing middle finger as a proper force for restoration of intrinsic function. We were pleased to use the extrinsic extensor that is found in same incision for the translocation of the index ray. The extrinsic flexor in extrinsic extensor was used. The extrinsic extensor of the middle finger was abscent in one patient.