reconstructive hand wrist surgery

✋ Congenital & Acquired Hand Deformities Hand deformities—whether congenital (present at birth) or acquired (developed later in life)—can significantly impact function, appearance, and quality of life. Treatment often involves a combination of reconstructive surgery, therapy, and sometimes prosthetics. 🧬 Congenital Hand Deformities These result from abnormal development in the womb, often due to genetic mutations, syndromes, or unknown causes. Common Types: 1. Syndactyly Fusion of two or more fingers. Can be simple (skin only) or complex (bones and tendons). Treatment: Surgical separation with skin grafting. 2. Polydactyly Extra digits (common in thumbs and little fingers). Can be preaxial (thumb side), postaxial (little finger side), or central. Treatment: Excision and reconstruction, often in infancy. 3. Radial Club Hand (Radial Deficiency) Underdevelopment or absence of the radius bone → wrist bends inward. Often associated with heart or kidney abnormalities. Treatment: Stretching, splinting, centralization surgery, tendon transfers. 4. Thumb Hypoplasia/Aplasia Underdeveloped or missing thumb. Graded I–V based on severity. Treatment: Tendon transfers, thumb reconstruction, or pollicization (index finger converted into a thumb). 5. Camptodactyly Non-traumatic flexion deformity, typically of the little finger. Treatment: Stretching, splinting, or surgical release if severe. 6. Cleft Hand (Ectrodactyly) “Split hand” or lobster-claw deformity. Central digit(s) missing, causing a cleft. Treatment: Reconstruction to improve grip and appearance. 🛠️ Acquired Hand Deformities These develop after birth due to trauma, disease, or repetitive stress. Common Causes: 1. Trauma Fractures, tendon/nerve injuries, burns. Treatment: Surgical repair, tendon transfers, bone grafts, microsurgery. 2. Arthritis Rheumatoid arthritis and osteoarthritis can lead to deformities like: Swan-neck deformity Boutonnière deformity Ulnar drift Treatment: Medication, splinting, joint reconstruction or fusion. 3. Dupuytren’s Contracture Thickening of fascia in the palm → fingers (esp. ring & little) curl toward palm. Treatment: Collagenase injections, needle aponeurotomy, or surgical fasciectomy. 4. Nerve Injuries Ulnar nerve → Claw hand Median nerve → Ape thumb Radial nerve → Wrist drop Treatment: Nerve repair, tendon transfers, bracing. 5. Cerebral Palsy / Stroke Spastic deformities due to neurological disorders. Treatment: Splinting, botulinum toxin, muscle/tendon balancing, surgical release. 🧠 Multidisciplinary Management Hand surgeons (plastic, orthopedic, or microsurgeons) Occupational/physical therapists Pediatricians and geneticists (for congenital cases) Rheumatologists or neurologists (for systemic or acquired causes) 🎯 Goals of Treatment Restore function (grip, dexterity, sensation) Improve appearance and psychosocial confidence Prevent further deformity or contracture Support independence and daily living activities