Surgical Treatment ofCongenital Thumb Deformities (Including Psychological Impact of Correction)*

Congenital deformities of the hand l)resellt some of the most diffleult piohlems seeti by the hand surgeon. Decisions about the timing atid methods of reconstruction are complicated by problems of abnormal anatomy, uncertaiti growth, small struc-tures, and lack of patient motivation or cooperation. Despite the natural dexterity possessed by most children with hand atiomalies, the emotional iml)act of deformity on some children may stifle atteml)ts to train them to use their hands. Instead, the child may keep his deformed hand hidden in his pocket or elsewhere because he thinks it looks queer. Congenital deformities that include absence or major lack of function of the thumb illustrate the complexities of treating birth defects of the hand. Minor defornities of the thumb will not be considered. Between 1959 and 1963 eleven patients with floating thumb (pouce flottant) or coml)lete absence of the thumb were treated OIl the l)lastic service at the Johns Hopkins Hospital. This group of patients illustrates iiany general l)rincih)les of hand reair. Floating or absent thunb is an exanil)le of the general condition of congenita