Congenital hand anomalies

Surprisingly, many congenital hand anomalies cause little functional deficit. Children develop prehension with hands as they are, and they usually are not self-conscious of difference until they become socialized in school. In contrast, parents may be dismayed by the appearance of an anomalous hand and may be hoping that surgery can create a "normal" hand. The hand surgeon treating children with congenital hand anomalies must offer surgery to improve the child's function and cosmetic appearance, when possible, and counsel parents about what is and is not possible with the surgery. Early surgery is defined as that performed within the first 2 years of life. Advantages include the full potential for growth, development, and patterns of use; improved scarring; early incorporation of the reconstructed part; and reduced psychologic affect. Disadvantages of early surgery are increased technical difficulty and possible increased anesthetic risk. Most surgeons perform these operations when the patient is in the second year of life but no later than when the patient enters school.