Debulking and osteotomy procedures to correct severe macrodactyly deformity of hand in young patients.

Abstract

Purpose: This study aimed to propose and evaluate early debulking combined with corrective osteotomy for treating hand macrodactyly in young patients.

Methods: A retrospective study included 31 young patients (mean age 12.7 years) with severe hand macrodactyly. All underwent microsurgical debulking based on multiple pedicled flaps and osteotomy to reduce the volume soft tissues and shape the deformed finger, with a mean follow-up of 3.1 years. Clinical evaluations included ratios of finger length, circumference, and nail dimensions to the intact finger, as well as the range of motion (ROM) of metacarpophalangeal joint (MCPJ), and functional scores (Kapandji, ARAT, Barthel) before and after surgery. Vancouver Scar Scale scores, parent satisfaction, and complications were also assessed.

Results: The procedure preserved the finger, avoided ablation, and restored near-normal appearance. Preoperatively, affected fingers were 1.3 times longer, with PIPJ and DIPJ circumferences 1.5 and 1.7 times larger than intact fingers. At the last follow-up, these ratios improved to 1.1, 1.2, and 1.2, respectively. Nail length and width, initially 1.7 and 1.6 times larger, normalized to 1.0 and 1.1 times. MCPJ ROM improved from 41° to 69°. Functional scores rose significantly: Kapandji from 6 to 9, ARAT from 33 to 53, and Barthel from 95 to 98. Vancouver Scar Scale averaged 2, and all parents expressed satisfaction.

Conclusion: This approach reduces finger volume, preserves fingers, improves functional outcomes, and minimizes adverse impacts on quality of life, offering a promising option for severe hand macrodactyly.