Excellencies - Hand Surgery

Congenital Malformations

What they are

The hand, morphologically complete and properly functioning, represents in man, from birth, an indispensable element for life.
It allows thanks to the gripper and gripping function, supported by the presence of an opposable thumb, the manipulation of objects and their use, the exploration of the surrounding world and learning.
The malformations of the hand, with an average of 1 child out of 1500 born, are manifold and of different severity. Among the most common examples are the union of two or more fingers (indactyly), the presence of supernumerary fingers (polidactyly), the absence of one or more fingers (agenesia), the deformation in bent position of fingers (camptodactyly), the lateral deviation of fingers (clinodactyly), the presence of shorter fingers than normal (brachidactyly).
Other malformative conditions are found in syndromic frameworks, where the problem of the hands is associated with abnormalities diffused on the four limbs or localized in the skull-facial district or in deep organs (kidney, heart, circulatory system).
Some of the best-known malformative syndromes are arthrogriposis, Down’s syndrome and Apert syndrome. These clinical pathological conditions are followed by an important functional deficit which will then affect the child’s psychophysical development, behaviour and relationship life. It is therefore necessary to make a diagnosis at birth and intervene on the malformative pathology as early as possible; it is in fact from 10 to 18 months that the brain becomes aware of the functions of the hand and learns to use it, adapting mental patterns to its morphological and functional development.

How to care

The treatment of malformations involves in most cases one or more surgical moments to give the Child a useful hand, each of them associated with a rehabilitation treatment.
Physiotherapy, which is normally carried out through play, will be essential to teach the child to use the “new” hand. The surgical act, although fundamental in anatomical and reconstructive terms, is only one stage in the long therapeutic journey.

For most of the time, children are followed by a hand therapist who, working with parents and surgeon, follows the different stages of the child’s maturity with the activities proposed, adapting them to his or her needs. Semiannual or annual surgical controls are however necessary to highlight additional needs of the Small or defects that occurred during growth.

It is in fact on the basis of the individual’s specific needs, found during development, that any surgical retouching is programmed.
The psychological aspect is of primary importance: parents are assisted by a specialist psychologist from the first visit. This figure is essential at different times; in principle, to face the impact with malformation, then to learn how to manage it and deal with the immediate consequences, such as intervention and post-operative and not least to understand how to illustrate and describe one’s condition to the child.