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Thirty-seven children with congenital (n = 32) or post-traumatic (n = 5) hand anomalies underwent unilateral or bilateral toe transfers. All had undergone preoperative counselling. After rehabilitation and more than 1 year after surgery, the children and their parents were reviewed by a clinical psychologist to assess the psychosocial outcome of the surgery. A high level of satisfaction was reported with regard to the surgery, in terms of function, cosmesis, donor site, psychosocial wellbeing and the reactions of others. This was true regardless of the gender of the child. However, there was a tendency for the children to be more positive in their responses than their parents.

An analysis of 39 patients (40 hands) who underwent an extensor indicis proprius opponensplasty was carried out. Of these, 29 hands had simultaneous adjuvant surgery to correct other deformities. The mean follow-up period was 33.8 months. Excellent or good results were seen in 87.5%, fair in 10% and poor in 2.4% hands.

Extensor indicis proprius has been used as a transfer to overcome passively correctable camptodactyly. The transferred tendon is accessible, expendable and synchronous. Early results are encouraging.

From a review of 57 patients with flexion deformity of the fingers (camptodactyly), 21 patients with 38 digits treated operatively had 18% good or excellent results, whereas 14 patients (41 digits) treated conservatively had 66% good or excellent results. Mild deformities responded well to splints and stretching. Moderate deformities treated operatively gained extension but at the loss of finger flexion. Severe deformities had improvement in extension (averaging 19 degrees in operative cases and 27 degrees in conservative), but there was significant loss of flexion in the operative group. Overall, 16 of 21 patients had loss of flexion after operative treatment. Conservative treatment of camptodactyly is recommended for digits with less than 60 degrees lack of extension. Operative treatment should be reserved for failed conservative treatment. Early joint motion post-operatively appears essential and surgical procedures that immobilize the P.I.P. joints should be avoided.

Centralisation of the carpus on top of the distal end of the ulna in radial club hand of types III and IV has been performed by gradual distraction. For this purpose, I have used the apparatus originally developed for lengthening of digital structures and the forearm. This technique avoids extensive dissection and acute stretching of the radial neuro-vascular structures. Experience has shown that gradual distraction is a safe and relatively simple method for correction of the deformity, particularly in long-standing and neglected cases.

The skin of the dorsal aspect of the forearm is supplied by several cutaneous branches of the posterior interosseous artery. This vascular anatomy permits the surgeon to obtain an island flap of the dorsal forearm based on the distal anastomosis between the two interosseous arteries at the distal part of the interosseous space. This flap can reliably be transferred to different skin defects of the hand such as those created by correction of an adduction contracture of the first web space, or on the back or front of the wrist level. Its principal advantages are that it is a thin flap with excellent circulation and that it is possible to close the donor area primarily provided the island flap is not wider than 3 to 4 cm. The procedure has been employed in 25 patients with satisfactory results.