Congenital Differences-Ray Resection for Progressive Macrodactyly of the Hand; Surgical Technique and Illustrative Cases

Ray Resection for Progressive Macrodactyly of the Hand; Surgical Technique and Illustrative Cases

Pdf Summary

Macrodactyly is a rare condition that causes overgrowth of one or more digits in the hand. Surgical intervention is often required to improve the size and function of the affected digits. In cases where the affected digit(s) are rapidly growing in size, ray resection amputation may be the most appropriate treatment option. Ray resection involves removing the entire digit, including the bones, tendons, and nerves, to create a more functional and aesthetic hand with only one surgery. Thumb ray resection is not advised unless followed by pollicization or microvascular toe transfer. Other surgical options for thumb reconstruction include soft tissue debulking, osseous shortening, and epiphysiodesis. <br /><br />Macrodactyly is typically present at birth and can be either static or progressive, depending on the rate of digital overgrowth. Surgical techniques for less severe cases may involve soft tissue debulking or osseous pathoanatomy correction. Ray resection involves making dorsal and volar hand incisions, identifying the neurovascular bundles, transecting the tendons and arteries, and disarticulating the digit at the carpo-metacarpal joint. The remaining digits are rearranged and secured, and excess skin is excised. <br /><br />Postoperative management includes immobilizing the hand with a cast or splint, followed by hand therapy for edema control, scar massage, and mobilization. Complications of the surgery can include skin flap necrosis, scarring, stiffness, and neurovascular compromise. Case illustrations are provided to demonstrate the successful outcomes achievable with ray resection in severe macrodactyly cases. It is important for surgeons to carefully consider the best treatment option for each patient, taking into account the functional and aesthetic goals and potential long-term outcomes.

Keywords

Macrodactyly

overgrowth

digits

hand

surgical intervention

ray resection amputation

thumb ray resection

thumb reconstruction

soft tissue debulking

osseous shortening