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present case surgical intervention was undertaken at
6 years of age, albeit with a good outcome.
The cleft closure is achieved by excision of excess tissue
including the third metacarpal and transverse bone bar
if present. To hold the diverging metacarpals together,
numerous techniques have been employed, such as heavy
chromic catgut sutures or stainless steel wires, the latter
done in the present case. For the restoration of the first
[12]
web space, Snow and Littler advocated syndactyly release
and utilization of skin from the palmar side. Barsky et al.
[13]
employed a diamond-shaped flap from the cleft area itself
to create a web space. In our case, the first web space
[12]
was created surgically in the right hand by simple closure
with a series of Z-plasties. The child may require rotational
osteotomies of the metacarpals, especially the marginal ones,
Figure 5: Functional and cosmetic outcome 1 year after surgery
[12]
to achieve a useful pincer grasp if not restored adequately.
No such procedure was done in this case as the patient and
Contraction of the first web space and limitation of thumb relatives were satisfied with the primary surgery outcome.
adduction is the main functional handicap encountered in Surgery for cleft foot is rarely required for hallux valgus
such cases, based on which Manske and Halikis devised a correction and still rarer for cosmetic reasons. [14]
severity classification. [11]
Typical and atypical cleft hand deformities occur with
Numerous clinical associations of SHFM have been varying degrees of severity. Children learn to adapt
documented; cleft lip/palate seems to be a consistent from an early age and frequently develop remarkable
accompanying manifestation. Such manifestations pose functionality. If surgery is to be done, it should be planned
airway difficulties which can lead to a potential higher carefully for each patient. The aim of surgery in these
morbidity and mortality. The constellation of findings cases is mostly cosmetic. Any surgical procedure done
most commonly reported is ectrodactyly ectodermal should not jeopardize existing functions of the hand.
dysplasia cleft lip/palate syndrome – ectrodactyly (SHFM),
ectodermal dysplasia (coarse dry skin, glandular
abnormalities), and cleft lip/palate. In the present case, REFERENCES
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116 Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014