Cleft Hand 의 새로운 분류 및 치료

Abstract

Cleft hand is a central deficiency deriving from an embryologically abnormal development of the hand. Its variation is so wide that there are many synonyms for it, i.e. central hypoplasia, split hand, lobster claw hand, ectrodactyly, oligodactyly and so forth. Also there are many classification systems for this anomaly. The classification of the cleft hand most widely used clinically is that of the typical and atypical types advocated by Lange. Since then various groupings are being considered, but no complete classification has been established as yet. In 1970, Maisels suggested that there may be a centripetal suppression of the developing hand plate. A mild form of the deformity presents a simple cleft with no missing tissues. In a more severe form, one finger may be missing. The radial rays are then progressively supressed, eventually leading to the loss of the ulnar rays. Finally, a single digit or even a hypoplastic hand may be left. This theory seems reasonable and is seen in the general group classified as cleft hand. We modified the existing classification of the cleft hand into 6 types based on the number of digits in defect and Maisels´ centripetal suppression concept. Treatment of the cleft hand involves cosmetic and functional considerations. Reduction of wide interdigital space and cleft by transfer of dorsally based skin flap, separation of syndactyly between thumb and index finger, and metacarpal transfer of index finger to the ulnar side are considered for cosmetic and functional reconstructions. During the last 4 years, total of 17cases of cleft hand in 13 patients have undertaken new classification and surgical treatment with good aesthetical and functional results.