Plastic Surgery>>>>>Hand surgery
Question 3#

Correction of radial hand deformity is not indicated in patients that present: 

a. With thrombocytopenia with absent radius (TAR) syndrome
b. With Fanconi’s anaemia
c. With Holt-Oram syndrome
d. As well-adapted adults
e. All of the above

Correct Answer is D

Comment:

As well-adapted adults. Adults well adjusted to the use of their radial dysplastic hand are not candidates for surgical reconstruction as they are able to perform all the activities of daily living with the hand as it is. Bayne outlined five categories of patients in which treatment is contraindicated: 1) patients with minimal anomalies; 2) patients with severe associated anomalies, who have severe retardation, poor prognosis and short predicted lifespan; 3) adult or older patients, who have adjusted to the disability and have acquired dexterity in performing activities of daily living; 4) patients with stiff elbows in which the straightened hand will not be able to reach the mouth or the perineum; and, 5) patients with severe soft tissue contractures that also involve the neurovascular structures.

References:

  1. Dobyns JH, Wood VE, Bayne LG. Congenital hand deformities. In: Operative hand surgery, Vol 1, 3rd ed. Green DP, Ed. New York, USA: Churchill Livingstone; 1993: 288-303.
  2. Bayne LG. Radial deficiencies. In: Reconstruction of the child’s hand. Carter PR, Ed. New York, USA: Lea and Febiger; 1991: 187-97.