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      Factors affecting hand cosmesis and the aesthetic impact of surgery on congenital hand differences in Finland

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          Abstract

          We assessed the appearance and cosmetic impact of surgery in congenitally different hands in Finland. A questionnaire was sent to 1165 respondents (786 female) with a mean age of 33 years (range 3–84). Participants were shown nine image pairs and seven pairs of pre- and postoperative images twice in a random order and asked to choose the more cosmetically pleasing one. We found that the appearance and number of fingers had an important aesthetic role, with higher number and more normal appearing digits consistently scoring higher than its counterpart (range 59–99%). Postoperative appearances were perceived as better than preoperative ones in syndactyly (98%), thumb duplication (92%), cleft hand (93%) and radial dysplasia (99%). Toe transfer and pollicization had little impact on cosmesis. This study demonstrated that surgery could improve cosmesis in congenitally different hands and overall, most respondents prefer an appearance that is as close as possible to normality. Level of evidence: IV

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          Developmental biology and classification of congenital anomalies of the hand and upper extremity.

          James A. Tonkin, Dine J Feenstra, Kerby C Oberg … (2010)
          Recent investigations into the mechanism of limb development have clarified the roles of several molecules, their pathways, and interactions. Characterization of the molecular pathways that orchestrate limb development has provided insight into the etiology of many limb malformations. In this review, we describe how the insights from developmental biology are related to clinically relevant anomalies and the current classification schemes used to define, categorize, and communicate patterns of upper limb malformations. We advocate an updated classification scheme for upper limb anomalies that incorporates our current molecular perspective of limb development and the pathogenetic basis for malformations using dysmorphology terminology. We anticipate that this scheme will improve the utility of a classification as a basis for diagnosis, treatment, and research. Copyright © 2010. Published by Elsevier Inc.
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            Epidemiology of congenital upper limb anomalies in 562 children born in 1997 to 2007: a total population study from stockholm, sweden.

            Anna Gerber Ekblom, Tobias Laurell, Marianne Arner (2010)
            There are few true epidemiological studies of congenital anomalies of the upper limb (CULA) on total populations in the literature, and most incidence studies are hospital based. The purposes of this study were to describe the epidemiology and classify all CULA in a region of Sweden during an 11-year period. Between 1997 and 2007, there were 261,914 live births in the Stockholm region. A total of 562 children born during this period were found to have CULA. From medical records and available radiographs, all cases were analyzed regarding the type of congenital anomaly, gender, laterality, occurrence among relatives, associated non-hand anomalies, and syndromes. All 585 main anomalies were classified according to the International Federation of Societies for Surgery of the Hand classification. Individuals with right- and left-side main anomalies belonging to different categories were counted as having 2 anomalies. The recorded incidence of CULA was 21.5 per 10,000 live births. Of the 562 children, 304 were boys. The anomalies affected the right side only in 169 children, the left side only in 186, and both sides in 207. Non-hand anomalies were recorded in 129 children, most commonly in the lower limbs. In 99 children, there was a known occurrence among relatives. Failure of differentiation was the most common category (276 of 585) followed by duplication (155 of 585), failure of formation (103 of 585), undergrowth (18 of 585), generalized abnormalities and syndromes (14 of 585), overgrowth (10 of 585), and constriction ring syndrome (9 of 585). The incidence of CULA in our region was similar to the only previously comparable total population study from Western Australia. The minor differences in incidences between the categories according to the International Federation of Surgical Societies of the Hand may be due to variations in classification strategy. The results of the present study can be used as a reference of CULA in a total population. Copyright © 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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              Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public.

              Despina A. Papamanou, Panagiotis Christou, Nikolaos Gkantidis … (2013)
              The aesthetic outcome of cleft treatment is of great importance due to its complex management and the psychosocial consequences of this defect. The aim of the study was to assess the aesthetic evaluations of patients following cleft surgery by various groups and investigate potential associations of the assessments with life quality parameters. Head photos of 12 adult patients with treated unilateral cleft lip and palate were evaluated by laypeople and professionals. A questionnaire was distributed and answered by the patients and their parents. Intra-panel agreement was high (α > 0.8) for laypeople and professionals. Between-groups agreement was high for both laypeople and professionals, but not when patients and/or parents were tested. Professionals, parents, and patients were more satisfied with patients' appearance than laypeople, although in general all groups were not highly satisfied. Low satisfaction with aesthetics correlated with increased self-reported influence of the cleft in the patients' social activity and professional life (0.56 < rho < 0.74, p < 0.05). These findings highlight the observed negative influence of the cleft on the patient's social activity and professional life and underline the need for the highest quality of surgical outcome for this group of patients. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Hand Surg Eur Vol
                Journal ID (iso-abbrev): J Hand Surg Eur Vol
                Journal ID (publisher-id): JHS
                Journal ID (hwp): spjhs
                Title: The Journal of Hand Surgery, European Volume
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 1753-1934
                ISSN (Electronic): 2043-6289
                Publication date (Electronic): 30 November 2022
                Publication date (Print): April 2023
                Volume: 48
                Issue: 4
                Pages: 333-340
                Affiliations
                [1 ]Department of Pediatric Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Finland
                [2 ]Department of Surgery, Central Hospital of South Karelia, Lappeenranta, Finland
                [3 ]Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Finland
                [4 ]Department of Pediatric Surgery, Kuopio University Hospital, University of Eastern Finland, Finland
                Author notes
                [*]Noora Nietosvaara, New Children’s Hospital, Helsinki University Hospital, Stenbäckinkatu 9, 00290 Helsinki, Finland. Email: noorani@ 123456uef.fi
                Author information
                https://orcid.org/0000-0002-1415-1091
                Article
                Publisher ID: 10.1177_17531934221139698
                DOI: 10.1177/17531934221139698
                PMC ID: 10012396
                PubMed ID: 36448515
                SO-VID: 3a5196ef-482f-458e-8590-d411743d5618
                Copyright © © The Author(s) 2022
                License:

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 4 May 2022
                Date revision received : 31 October 2022
                Date accepted : 1 November 2022
                Categories
                Subject: Full Length Article
                Custom metadata
                typesetter ts2

                Keywords: hand,child,disability evaluation,upper extremity deformities,aesthetics
                Data availability:
                Keywords: hand, child, disability evaluation, upper extremity deformities, aesthetics

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