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Zigzag Deformity in Thumb Polydactyly - Secondary surgery may be needed

These are some of the most complex reconstructions we encounter give the joints going in opposing directions with many have different levels of deformity and hypoplasia. Success requires more than simple excision and radial collateral reconstruction.. it requires attention to several key areas at the initial surgery:
- First web space: Often tight and requires four flap z plasty to deepen the webspace
- Tendon realignment: Both flexor and extensor tendons typically need rebalancing, with suture buttons providing distal insertion realignment.
- Skeletal correction: Proximal phalanx osteotomy may be necessary to straighten the finger. Frequently the joints will limit the ultimate function and you will get a hint of their function from the flexion and extension creases.
- Ligament reconstruction: Standard capsuloperiosteal flap for joint reconstitution. Consider tendon grafts from spare parts if needed.
- Chondroplasty of the metacarpal head is needed to correct the deformity where the excised polydactyly once lived.
- Consider skin flaps to add bulk
- Overall balance: Careful reconstruction anticipating growth helps minimize recurrence and preserve motion.

Our goal is to get the reconstructed thumb well aligned (and don’t be fooled by a K wire that makes the finger straight) with all of the above maneuvers. We frequently cite that 20% or patients may require additional surgery as they grow but with zigzag deformities it may be more! Our goal is to provide the patient a reliable result, especially in the long-term.

In this secondary reconstruction case, you can see the initial zigzag deformity that the patient had reconstruction by another surgeon. There was still significant deformity coming from the proximal feelings so when the patient was a teenager underwent a corrective closing wedge osteotomy to have the thumb in an improved position.

#PediatricHandSurgery #congenitalhandsurgery #ThumbPolydactyly #ZigzagDeformity

Zigzag Deformity in Thumb Polydactyly - Secondary surgery may be needed

These are some of the most complex reconstructions we encounter give the joints going in opposing directions with many have different levels of deformity and hypoplasia. Success requires more than simple excision and radial collateral reconstruction.. it requires attention to several key areas at the initial surgery:
- First web space: Often tight and requires four flap z plasty to deepen the webspace
- Tendon realignment: Both flexor and extensor tendons typically need rebalancing, with suture buttons providing distal insertion realignment.
- Skeletal correction: Proximal phalanx osteotomy may be necessary to straighten the finger. Frequently the joints will limit the ultimate function and you will get a hint of their function from the flexion and extension creases.
- Ligament reconstruction: Standard capsuloperiosteal flap for joint reconstitution. Consider tendon grafts from spare parts if needed.
- Chondroplasty of the metacarpal head is needed to correct the deformity where the excised polydactyly once lived.
- Consider skin flaps to add bulk
- Overall balance: Careful reconstruction anticipating growth helps minimize recurrence and preserve motion.

Our goal is to get the reconstructed thumb well aligned (and don’t be fooled by a K wire that makes the finger straight) with all of the above maneuvers. We frequently cite that 20% or patients may require additional surgery as they grow but with zigzag deformities it may be more! Our goal is to provide the patient a reliable result, especially in the long-term.

In this secondary reconstruction case, you can see the initial zigzag deformity that the patient had reconstruction by another surgeon. There was still significant deformity coming from the proximal feelings so when the patient was a teenager underwent a corrective closing wedge osteotomy to have the thumb in an improved position.

#PediatricHandSurgery #congenitalhandsurgery #ThumbPolydactyly #ZigzagDeformity

Zigzag Deformity in Thumb Polydactyly - Secondary surgery may be needed

These are some of the most complex reconstructions we encounter give the joints going in opposing directions with many have different levels of deformity and hypoplasia. Success requires more than simple excision and radial collateral reconstruction.. it requires attention to several key areas at the initial surgery:
- First web space: Often tight and requires four flap z plasty to deepen the webspace
- Tendon realignment: Both flexor and extensor tendons typically need rebalancing, with suture buttons providing distal insertion realignment.
- Skeletal correction: Proximal phalanx osteotomy may be necessary to straighten the finger. Frequently the joints will limit the ultimate function and you will get a hint of their function from the flexion and extension creases.
- Ligament reconstruction: Standard capsuloperiosteal flap for joint reconstitution. Consider tendon grafts from spare parts if needed.
- Chondroplasty of the metacarpal head is needed to correct the deformity where the excised polydactyly once lived.
- Consider skin flaps to add bulk
- Overall balance: Careful reconstruction anticipating growth helps minimize recurrence and preserve motion.

Our goal is to get the reconstructed thumb well aligned (and don’t be fooled by a K wire that makes the finger straight) with all of the above maneuvers. We frequently cite that 20% or patients may require additional surgery as they grow but with zigzag deformities it may be more! Our goal is to provide the patient a reliable result, especially in the long-term.

In this secondary reconstruction case, you can see the initial zigzag deformity that the patient had reconstruction by another surgeon. There was still significant deformity coming from the proximal feelings so when the patient was a teenager underwent a corrective closing wedge osteotomy to have the thumb in an improved position.

#PediatricHandSurgery #congenitalhandsurgery #ThumbPolydactyly #ZigzagDeformity

Zigzag Deformity in Thumb Polydactyly - Secondary surgery may be needed

These are some of the most complex reconstructions we encounter give the joints going in opposing directions with many have different levels of deformity and hypoplasia. Success requires more than simple excision and radial collateral reconstruction.. it requires attention to several key areas at the initial surgery:
- First web space: Often tight and requires four flap z plasty to deepen the webspace
- Tendon realignment: Both flexor and extensor tendons typically need rebalancing, with suture buttons providing distal insertion realignment.
- Skeletal correction: Proximal phalanx osteotomy may be necessary to straighten the finger. Frequently the joints will limit the ultimate function and you will get a hint of their function from the flexion and extension creases.
- Ligament reconstruction: Standard capsuloperiosteal flap for joint reconstitution. Consider tendon grafts from spare parts if needed.
- Chondroplasty of the metacarpal head is needed to correct the deformity where the excised polydactyly once lived.
- Consider skin flaps to add bulk
- Overall balance: Careful reconstruction anticipating growth helps minimize recurrence and preserve motion.

Our goal is to get the reconstructed thumb well aligned (and don’t be fooled by a K wire that makes the finger straight) with all of the above maneuvers. We frequently cite that 20% or patients may require additional surgery as they grow but with zigzag deformities it may be more! Our goal is to provide the patient a reliable result, especially in the long-term.

In this secondary reconstruction case, you can see the initial zigzag deformity that the patient had reconstruction by another surgeon. There was still significant deformity coming from the proximal feelings so when the patient was a teenager underwent a corrective closing wedge osteotomy to have the thumb in an improved position.

#PediatricHandSurgery #congenitalhandsurgery #ThumbPolydactyly #ZigzagDeformity

Zigzag Deformity in Thumb Polydactyly - Secondary surgery may be needed

These are some of the most complex reconstructions we encounter give the joints going in opposing directions with many have different levels of deformity and hypoplasia. Success requires more than simple excision and radial collateral reconstruction.. it requires attention to several key areas at the initial surgery:
- First web space: Often tight and requires four flap z plasty to deepen the webspace
- Tendon realignment: Both flexor and extensor tendons typically need rebalancing, with suture buttons providing distal insertion realignment.
- Skeletal correction: Proximal phalanx osteotomy may be necessary to straighten the finger. Frequently the joints will limit the ultimate function and you will get a hint of their function from the flexion and extension creases.
- Ligament reconstruction: Standard capsuloperiosteal flap for joint reconstitution. Consider tendon grafts from spare parts if needed.
- Chondroplasty of the metacarpal head is needed to correct the deformity where the excised polydactyly once lived.
- Consider skin flaps to add bulk
- Overall balance: Careful reconstruction anticipating growth helps minimize recurrence and preserve motion.

Our goal is to get the reconstructed thumb well aligned (and don’t be fooled by a K wire that makes the finger straight) with all of the above maneuvers. We frequently cite that 20% or patients may require additional surgery as they grow but with zigzag deformities it may be more! Our goal is to provide the patient a reliable result, especially in the long-term.

In this secondary reconstruction case, you can see the initial zigzag deformity that the patient had reconstruction by another surgeon. There was still significant deformity coming from the proximal feelings so when the patient was a teenager underwent a corrective closing wedge osteotomy to have the thumb in an improved position.

#PediatricHandSurgery #congenitalhandsurgery #ThumbPolydactyly #ZigzagDeformity

Zigzag Deformity in Thumb Polydactyly - Secondary surgery may be needed

These are some of the most complex reconstructions we encounter give the joints going in opposing directions with many have different levels of deformity and hypoplasia. Success requires more than simple excision and radial collateral reconstruction.. it requires attention to several key areas at the initial surgery:
- First web space: Often tight and requires four flap z plasty to deepen the webspace
- Tendon realignment: Both flexor and extensor tendons typically need rebalancing, with suture buttons providing distal insertion realignment.
- Skeletal correction: Proximal phalanx osteotomy may be necessary to straighten the finger. Frequently the joints will limit the ultimate function and you will get a hint of their function from the flexion and extension creases.
- Ligament reconstruction: Standard capsuloperiosteal flap for joint reconstitution. Consider tendon grafts from spare parts if needed.
- Chondroplasty of the metacarpal head is needed to correct the deformity where the excised polydactyly once lived.
- Consider skin flaps to add bulk
- Overall balance: Careful reconstruction anticipating growth helps minimize recurrence and preserve motion.

Our goal is to get the reconstructed thumb well aligned (and don’t be fooled by a K wire that makes the finger straight) with all of the above maneuvers. We frequently cite that 20% or patients may require additional surgery as they grow but with zigzag deformities it may be more! Our goal is to provide the patient a reliable result, especially in the long-term.

In this secondary reconstruction case, you can see the initial zigzag deformity that the patient had reconstruction by another surgeon. There was still significant deformity coming from the proximal feelings so when the patient was a teenager underwent a corrective closing wedge osteotomy to have the thumb in an improved position.

#PediatricHandSurgery #congenitalhandsurgery #ThumbPolydactyly #ZigzagDeformity

08 September 2025 at 8 pm (CET)
PULPe have assembled an experienced international faculty for the

CASE DISCUSSIONS 2025
Interactive webinar with international experts
September 8th 2025 8 pm CET

The webinar will be valuable to residents/trainees, therapists and seasoned surgeons who will all gain from the breadth of the program.
There will be ample time for Q and A.
The session is recorded

Duration: 60 min
Registration: free but mandatory (Link on their website) #pediatrichandsurgery

08 September 2025 at 8 pm (CET)
PULPe have assembled an experienced international faculty for the

CASE DISCUSSIONS 2025
Interactive webinar with international experts
September 8th 2025 8 pm CET

The webinar will be valuable to residents/trainees, therapists and seasoned surgeons who will all gain from the breadth of the program.
There will be ample time for Q and A.
The session is recorded

Duration: 60 min
Registration: free but mandatory (Link on their website) #pediatrichandsurgery

Pediatric Hand Surgery Principles ✍🏽 Scarring
All wounds heal with scar but how can we decrease scarring for our patients? There is no magic cream but there is a formula.
1. Surgery. Our surgery is the most important aspect, that we had an efficient surgery that was quick, efficient and safe.. Resulting in maintaining blood supply to tissues so they heal and that the skin graft site has healthy tissue. Keep the tissue moist during the case (dessication or drying out results in tissue death). Tissue death results in more scarring rather than primarily healing. We want primary healing!! Our goal is to do an efficient surgery (have a great assistant) to get good healing. Put a dressing on and cast it for four weeks (dressing changes do not do much.. In congenital hand surgery everything will heal well if all the tissues lined up well). Use absorbable sutures.
2. Cast Education. Our surgery is “easy” (compared to the after care) because the child is under general anesthesia and we can do the surgery precisely. Once the child is awake the key component is keep the the surgery exactly as we performed it. For example if we do a large surgery and placed a pin and then the cast comes off after the first week and the pin is removed early.. That defies our goal of leaving it exactly as we made it and so take your time place a long arm club cast (2 inch soft cast is a great option). Therefore the education that we perform with the family becomes important on keeping the cast rules (keep the cast, clean, dry, elevated and supervision).

3. Scar Education (comment below)

#PediatricHandSurgery#CongenitalHand #Orthopedics #PlasticSurgery #HandSurgery #scar #scarring #scarmanagement

Pediatric Hand Surgery Principles ✍🏽 Scarring
All wounds heal with scar but how can we decrease scarring for our patients? There is no magic cream but there is a formula.
1. Surgery. Our surgery is the most important aspect, that we had an efficient surgery that was quick, efficient and safe.. Resulting in maintaining blood supply to tissues so they heal and that the skin graft site has healthy tissue. Keep the tissue moist during the case (dessication or drying out results in tissue death). Tissue death results in more scarring rather than primarily healing. We want primary healing!! Our goal is to do an efficient surgery (have a great assistant) to get good healing. Put a dressing on and cast it for four weeks (dressing changes do not do much.. In congenital hand surgery everything will heal well if all the tissues lined up well). Use absorbable sutures.
2. Cast Education. Our surgery is “easy” (compared to the after care) because the child is under general anesthesia and we can do the surgery precisely. Once the child is awake the key component is keep the the surgery exactly as we performed it. For example if we do a large surgery and placed a pin and then the cast comes off after the first week and the pin is removed early.. That defies our goal of leaving it exactly as we made it and so take your time place a long arm club cast (2 inch soft cast is a great option). Therefore the education that we perform with the family becomes important on keeping the cast rules (keep the cast, clean, dry, elevated and supervision).

3. Scar Education (comment below)

#PediatricHandSurgery#CongenitalHand #Orthopedics #PlasticSurgery #HandSurgery #scar #scarring #scarmanagement

Principle ✍🏽 Staging Surgery
A pediatric hand surgeon has time on their side when it comes to congenital hand surgery. You can always wait for the patient to grow larger (add some kilograms in size) to ensure that the surgery will be safe in your hands. Although we want to perform as much reconstructive surgery as possible and minimize exposure to general anesthesia, the goal is always safety with what we can do technically. There are some indications for performing all the surgery at one time, however staging surgery is a good option in most cases. Families will understand if there was a clear stopping point to the surgery to maximize safety.

A general rule in syndactyly surgery is to try to avoid operating on both radial and ulnar volar sides of a finger to avoid vascular compromise (i.e. you protect both digital neurovascular bundles because if you make the closure too tight this may result in digit loss). For example for syndactyly cases where there is fourth and third webspace syndactyly, you can start with the fourth webspace in one surgery, and then perform the third webspace in a second surgery. There is no rush to get to the second stage of this surgery because the goal is for the family to have been able to do scar massage and splinting. Make sure that the webspace treated is doing well before moving onto the next stage (in most cases at least 6 months). The entire goal of syndactyly surgery is to separate the fingers and not cause them to scar back together (we want to avoid webcreep if possible in the short term understanding they are always at risk in the long term when they become adolescents).

#PediatricHandSurgery#CongenitalHand #Orthopedics #PlasticSurgery #HandSurgery #Genetics #syndactyly #greigcephalopolysyndactyly

Principle ✍🏽 Staging Surgery
A pediatric hand surgeon has time on their side when it comes to congenital hand surgery. You can always wait for the patient to grow larger (add some kilograms in size) to ensure that the surgery will be safe in your hands. Although we want to perform as much reconstructive surgery as possible and minimize exposure to general anesthesia, the goal is always safety with what we can do technically. There are some indications for performing all the surgery at one time, however staging surgery is a good option in most cases. Families will understand if there was a clear stopping point to the surgery to maximize safety.

A general rule in syndactyly surgery is to try to avoid operating on both radial and ulnar volar sides of a finger to avoid vascular compromise (i.e. you protect both digital neurovascular bundles because if you make the closure too tight this may result in digit loss). For example for syndactyly cases where there is fourth and third webspace syndactyly, you can start with the fourth webspace in one surgery, and then perform the third webspace in a second surgery. There is no rush to get to the second stage of this surgery because the goal is for the family to have been able to do scar massage and splinting. Make sure that the webspace treated is doing well before moving onto the next stage (in most cases at least 6 months). The entire goal of syndactyly surgery is to separate the fingers and not cause them to scar back together (we want to avoid webcreep if possible in the short term understanding they are always at risk in the long term when they become adolescents).

#PediatricHandSurgery#CongenitalHand #Orthopedics #PlasticSurgery #HandSurgery #Genetics #syndactyly #greigcephalopolysyndactyly

Cerebral palsy (CP) arises from early injury to the developing brain, leading to motor dysfunction that may include spasticity, dystonia, weakness, and impaired coordination. These children are frequently underserved in most areas and their cases are frequently quite challenging.

Care is best provided through a multidisciplinary team including pediatric neurologists, physiatrists (physical medicine and rehabilitation), therapists, and surgeons working together to optimize function and quality of life.

For select patients, surgery can play a role, but only after careful serial examinations help distinguish spasticity from dystonia. This distinction guides whether interventions such as tendon transfers, wrist fusion, or selective releases may improve hand use. As we know we are hoping to slightly improve their position and function. There is never a home run in these cases because of the complexity of the deformity.

Importantly, the House Functional Classification provides a structured way to assess upper extremity use. Even slight improvements in classification after surgery can represent meaningful functional gains. For patients that have voluntary control consider video evaluation with SHUEE (Shriners Hospital Upper Extremity Evaluation) that can be done coordinated with a pediatric hand therapist.

Details for this case are in the images. Significant Volkmann’s angle hence the need for addressing forearm flexors. Although this patient did not have volitional (voluntary) control of her right arm —> she had pain and was unable to lay her wrist comfortably in her chair. Fortunately these both resolved after this complex surgery.

Our role as pediatric hand surgeons is to bring technical expertise within a collaborative care model which always aiming for functional gains that are meaningful to the child and family.

#PediatricHandSurgery #CerebralPalsy #MultidisciplinaryCare #PMR #wristfusion

Cerebral palsy (CP) arises from early injury to the developing brain, leading to motor dysfunction that may include spasticity, dystonia, weakness, and impaired coordination. These children are frequently underserved in most areas and their cases are frequently quite challenging.

Care is best provided through a multidisciplinary team including pediatric neurologists, physiatrists (physical medicine and rehabilitation), therapists, and surgeons working together to optimize function and quality of life.

For select patients, surgery can play a role, but only after careful serial examinations help distinguish spasticity from dystonia. This distinction guides whether interventions such as tendon transfers, wrist fusion, or selective releases may improve hand use. As we know we are hoping to slightly improve their position and function. There is never a home run in these cases because of the complexity of the deformity.

Importantly, the House Functional Classification provides a structured way to assess upper extremity use. Even slight improvements in classification after surgery can represent meaningful functional gains. For patients that have voluntary control consider video evaluation with SHUEE (Shriners Hospital Upper Extremity Evaluation) that can be done coordinated with a pediatric hand therapist.

Details for this case are in the images. Significant Volkmann’s angle hence the need for addressing forearm flexors. Although this patient did not have volitional (voluntary) control of her right arm —> she had pain and was unable to lay her wrist comfortably in her chair. Fortunately these both resolved after this complex surgery.

Our role as pediatric hand surgeons is to bring technical expertise within a collaborative care model which always aiming for functional gains that are meaningful to the child and family.

#PediatricHandSurgery #CerebralPalsy #MultidisciplinaryCare #PMR #wristfusion

Pediatric Hand Surgery is a field in itself given the spectrum of pathology that requires a detailed and comprehensive approach. We have the goal of teaching practical aspects of taking care of children including hand therapy and comprehensive care. Please share with any student, resident, fellow, or colleague! If you have a case with a teaching point or educational please collaborate with our IG page. More to come!

#pediatrichandsurgery

Pediatric Hand Surgery is a field in itself given the spectrum of pathology that requires a detailed and comprehensive approach. We have the goal of teaching practical aspects of taking care of children including hand therapy and comprehensive care. Please share with any student, resident, fellow, or colleague! If you have a case with a teaching point or educational please collaborate with our IG page. More to come!

#pediatrichandsurgery

Oculodentodigital Dysplasia (ODDD) - Check out this case and see the color match of skin grafts!

Genetics: Autosomal dominant with high penetrance; caused by GJA1 gene mutation.

Ocular findings: Microphthalmia, microcornea, glaucoma, hypertelorism, hypotelorism.

Dental findings: Small teeth, enamel hypoplasia, prone to caries.

Facial features: Pinched nose, hypoplastic alae, thin anteverted nares, prominent epicanthal folds.

Skin/Nails/Hair: Follicular hyperkeratosis, brittle nails, hypotrichosis.

Neurological: Late-onset leukodystrophy with spastic paraparesis, ataxia, weakness, dysarthria, seizures, neurogenic bladder, and mild cognitive delay. White matter deterioration is common.

Hands:

80% show deformities.

Ulnar-sided syndactyly is typical, and bilateral

Abnormal/absent small finger middle phalanx, camptodactyly or clinodactyly.

Broad metacarpals or phalanges.

In this case:
In cases with fourth webspace syndactyly, early reconstruction (doesn’t have to be at 6 months but okay to wait until 9 months to make it technically easier) with Buck-Gramcko flaps is critical. Make your standard marking and you know for sure you will need a lot of skin because of the deficiency! Pinning of the ring finger is helpful given the amount of camptodactyly. Child was casted for four weeks with no wound care.

#PediatricHandSurgery #ODDD #Syndactyly #BuckGramckoFlap

Oculodentodigital Dysplasia (ODDD) - Check out this case and see the color match of skin grafts!

Genetics: Autosomal dominant with high penetrance; caused by GJA1 gene mutation.

Ocular findings: Microphthalmia, microcornea, glaucoma, hypertelorism, hypotelorism.

Dental findings: Small teeth, enamel hypoplasia, prone to caries.

Facial features: Pinched nose, hypoplastic alae, thin anteverted nares, prominent epicanthal folds.

Skin/Nails/Hair: Follicular hyperkeratosis, brittle nails, hypotrichosis.

Neurological: Late-onset leukodystrophy with spastic paraparesis, ataxia, weakness, dysarthria, seizures, neurogenic bladder, and mild cognitive delay. White matter deterioration is common.

Hands:

80% show deformities.

Ulnar-sided syndactyly is typical, and bilateral

Abnormal/absent small finger middle phalanx, camptodactyly or clinodactyly.

Broad metacarpals or phalanges.

In this case:
In cases with fourth webspace syndactyly, early reconstruction (doesn’t have to be at 6 months but okay to wait until 9 months to make it technically easier) with Buck-Gramcko flaps is critical. Make your standard marking and you know for sure you will need a lot of skin because of the deficiency! Pinning of the ring finger is helpful given the amount of camptodactyly. Child was casted for four weeks with no wound care.

#PediatricHandSurgery #ODDD #Syndactyly #BuckGramckoFlap

Can you make the diagnosis just on X-ray? Save this one!☝️

Ellis-van Creveld (EVC) syndrome is a rare chondroectodermal dysplasia that pediatric hand surgeons should recognize early.

Classic hand feature: Hypoplastic distal phalanges, Postaxial polydactyly (Type A), syndactyly, and nail dysplasia

Associated conditions to look out for:
- Congenital heart disease (seen in about 50–60% of cases, especially atrial septal defects)
- Dental anomalies (conical teeth, enamel hypoplasia)
- Skeletal dysplasia (short limbs, narrow chest, disproportionate dwarfism)

For the pediatric hand surgeon, identifying hypoplastic distal phalanges on X-ray may be the first clue that leads to recognition of EVC. A multidisciplinary approach involving cardiology, pediatric hand surgery, dentistry, and genetics is crucial for comprehensive care.

#PediatricHandSurgery #EllisVanCreveld #CongenitalHand #GeneticsInHandSurgery #genetics #polydactylytypeA

Can you make the diagnosis just on X-ray? Save this one!☝️

Ellis-van Creveld (EVC) syndrome is a rare chondroectodermal dysplasia that pediatric hand surgeons should recognize early.

Classic hand feature: Hypoplastic distal phalanges, Postaxial polydactyly (Type A), syndactyly, and nail dysplasia

Associated conditions to look out for:
- Congenital heart disease (seen in about 50–60% of cases, especially atrial septal defects)
- Dental anomalies (conical teeth, enamel hypoplasia)
- Skeletal dysplasia (short limbs, narrow chest, disproportionate dwarfism)

For the pediatric hand surgeon, identifying hypoplastic distal phalanges on X-ray may be the first clue that leads to recognition of EVC. A multidisciplinary approach involving cardiology, pediatric hand surgery, dentistry, and genetics is crucial for comprehensive care.

#PediatricHandSurgery #EllisVanCreveld #CongenitalHand #GeneticsInHandSurgery #genetics #polydactylytypeA

Simple syndactyly releases in children that are older (5 years or older) typically require a little bit more skin with less availability. A great place to take skin from is the medial forearm! Avoid the groins at all costs because they can have sometimes darker pigmentation and can grow unwanted hair. You can draw a line from the ulnar styloid to the medial epicondyle (this has less hair bearing area take a look on yourself). Great color match. Easy harvest with the arm abducted and externally rotated (assistant can easily help your tension). You can take a lot of skin from this area and you can even harvest skin again from this area after waiting at least 12 months! The medial forearm also hides well and families will tell you that most people don’t notice this harvest site in their child.

#pediatrichandsurgery #syndactyly #skingraft #medialforearm

Simple syndactyly releases in children that are older (5 years or older) typically require a little bit more skin with less availability. A great place to take skin from is the medial forearm! Avoid the groins at all costs because they can have sometimes darker pigmentation and can grow unwanted hair. You can draw a line from the ulnar styloid to the medial epicondyle (this has less hair bearing area take a look on yourself). Great color match. Easy harvest with the arm abducted and externally rotated (assistant can easily help your tension). You can take a lot of skin from this area and you can even harvest skin again from this area after waiting at least 12 months! The medial forearm also hides well and families will tell you that most people don’t notice this harvest site in their child.

#pediatrichandsurgery #syndactyly #skingraft #medialforearm

Simple syndactyly releases in children that are older (5 years or older) typically require a little bit more skin with less availability. A great place to take skin from is the medial forearm! Avoid the groins at all costs because they can have sometimes darker pigmentation and can grow unwanted hair. You can draw a line from the ulnar styloid to the medial epicondyle (this has less hair bearing area take a look on yourself). Great color match. Easy harvest with the arm abducted and externally rotated (assistant can easily help your tension). You can take a lot of skin from this area and you can even harvest skin again from this area after waiting at least 12 months! The medial forearm also hides well and families will tell you that most people don’t notice this harvest site in their child. 🪄

#pediatrichandsurgery #syndactyly #skingraft #medialforearm

Simple syndactyly releases in children that are older (5 years or older) typically require a little bit more skin with less availability. A great place to take skin from is the medial forearm! Avoid the groins at all costs because they can have sometimes darker pigmentation and can grow unwanted hair. You can draw a line from the ulnar styloid to the medial epicondyle (this has less hair bearing area take a look on yourself). Great color match. Easy harvest with the arm abducted and externally rotated (assistant can easily help your tension). You can take a lot of skin from this area and you can even harvest skin again from this area after waiting at least 12 months! The medial forearm also hides well and families will tell you that most people don’t notice this harvest site in their child. 🪄

#pediatrichandsurgery #syndactyly #skingraft #medialforearm

Pediatric Hand Surgery Tool: The 67 blade is a beaver type blade that offers a lot of accuracy. Specifically not only does it have a small tip blade, but it has a bevel that allows you to incise with accuracy. This is fantastic for tiny surgeries that we perform with loupe magnification. You can have it on a short or long handle. If you’re doing a bilateral case, you likely will need a second one you should switch to a 15 C or a regular 15 if you’re cutting into bone or cartilage.

#pediatrichandsurgery #67blade

Pediatric Hand Surgery Tool: The 67 blade is a beaver type blade that offers a lot of accuracy. Specifically not only does it have a small tip blade, but it has a bevel that allows you to incise with accuracy. This is fantastic for tiny surgeries that we perform with loupe magnification. You can have it on a short or long handle. If you’re doing a bilateral case, you likely will need a second one you should switch to a 15 C or a regular 15 if you’re cutting into bone or cartilage.

#pediatrichandsurgery #67blade

Macrodactyly surgical care is very challenging. There are many times where we do discuss/recommend performing a ray amputation however, debulking is a reasonable approach for some patients. In this case debulking was performed only of the middle finger, corrective osteotomies (distal phalanx flexion and middle phalanx wedge), neurectomy of the radial nerve, and nail bed reduction. The blood supply to these tissues are poor and are frequently under tension so great Care must be taken with the tissue and also ensuring that sufficiently debulking is performed and to minimize the amount of tension of the skin flaps.

The finger was resulting in scissoring and after surgery was better able to make a fist. The patient will be followed over time to determine next steps and these are always challenging conversations with the parent. Growth plate closures may be needed in the future, along with additional debulking, and ray amputation is always offered as well.

#PediatricHandSurgery #Macrodactyly #CongenitalHand #HandSurgery #OvergrowthSyndromes

Macrodactyly surgical care is very challenging. There are many times where we do discuss/recommend performing a ray amputation however, debulking is a reasonable approach for some patients. In this case debulking was performed only of the middle finger, corrective osteotomies (distal phalanx flexion and middle phalanx wedge), neurectomy of the radial nerve, and nail bed reduction. The blood supply to these tissues are poor and are frequently under tension so great Care must be taken with the tissue and also ensuring that sufficiently debulking is performed and to minimize the amount of tension of the skin flaps.

The finger was resulting in scissoring and after surgery was better able to make a fist. The patient will be followed over time to determine next steps and these are always challenging conversations with the parent. Growth plate closures may be needed in the future, along with additional debulking, and ray amputation is always offered as well.

#PediatricHandSurgery #Macrodactyly #CongenitalHand #HandSurgery #OvergrowthSyndromes

Macrodactyly surgical care is very challenging. There are many times where we do discuss/recommend performing a ray amputation however, debulking is a reasonable approach for some patients. In this case debulking was performed only of the middle finger, corrective osteotomies (distal phalanx flexion and middle phalanx wedge), neurectomy of the radial nerve, and nail bed reduction. The blood supply to these tissues are poor and are frequently under tension so great Care must be taken with the tissue and also ensuring that sufficiently debulking is performed and to minimize the amount of tension of the skin flaps.

The finger was resulting in scissoring and after surgery was better able to make a fist. The patient will be followed over time to determine next steps and these are always challenging conversations with the parent. Growth plate closures may be needed in the future, along with additional debulking, and ray amputation is always offered as well.

#PediatricHandSurgery #Macrodactyly #CongenitalHand #HandSurgery #OvergrowthSyndromes

Macrodactyly surgical care is very challenging. There are many times where we do discuss/recommend performing a ray amputation however, debulking is a reasonable approach for some patients. In this case debulking was performed only of the middle finger, corrective osteotomies (distal phalanx flexion and middle phalanx wedge), neurectomy of the radial nerve, and nail bed reduction. The blood supply to these tissues are poor and are frequently under tension so great Care must be taken with the tissue and also ensuring that sufficiently debulking is performed and to minimize the amount of tension of the skin flaps.

The finger was resulting in scissoring and after surgery was better able to make a fist. The patient will be followed over time to determine next steps and these are always challenging conversations with the parent. Growth plate closures may be needed in the future, along with additional debulking, and ray amputation is always offered as well.

#PediatricHandSurgery #Macrodactyly #CongenitalHand #HandSurgery #OvergrowthSyndromes

Macrodactyly is a rare congenital overgrowth difference where one or more fingers grow disproportionately large due to abnormal overgrowth of bone, fat, nerves, and soft tissue. There typically is a dysregulation of growth pathways, including the PIK3CA/AKT signaling pathway.

Approaches to Care
- Medical therapies are emerging: targeted inhibitors (vijoice, no conflicts of interest) are being studied for children with progressive forms, aiming to slow growth and reduce deformity.
- Surgery remains the cornerstone but very challenging.
- Debulking procedures remove excess fatty and soft tissue while preserving function. Neurectomies are also performed. This helps to decrease it but doesn’t stop process.
- Epiphysiodesis or osteotomies can help control growth or realign the digit.
- Amputation is considered when function and reconstruction options are limited. Always good to offer this up front however family may not be interested.

#PediatricHandSurgery #Macrodactyly #CongenitalHand #HandSurgery #OvergrowthSyndromes

Macrodactyly is a rare congenital overgrowth difference where one or more fingers grow disproportionately large due to abnormal overgrowth of bone, fat, nerves, and soft tissue. There typically is a dysregulation of growth pathways, including the PIK3CA/AKT signaling pathway.

Approaches to Care
- Medical therapies are emerging: targeted inhibitors (vijoice, no conflicts of interest) are being studied for children with progressive forms, aiming to slow growth and reduce deformity.
- Surgery remains the cornerstone but very challenging.
- Debulking procedures remove excess fatty and soft tissue while preserving function. Neurectomies are also performed. This helps to decrease it but doesn’t stop process.
- Epiphysiodesis or osteotomies can help control growth or realign the digit.
- Amputation is considered when function and reconstruction options are limited. Always good to offer this up front however family may not be interested.

#PediatricHandSurgery #Macrodactyly #CongenitalHand #HandSurgery #OvergrowthSyndromes

Bilobe Flap with Soft Tissue Release for Radial Longitudinal Deficiency

In select cases of radial longitudinal deficiency. A bilobe flap (volar based hides a bit better) offers a powerful local option for local tissue rearrangement after soft tissue release of the tight radial sided structures. This surgery maintains wrist motion however does not get the extremity completely straight. Use silk sutures to help retract the flaps to maintain the blood supply (do not hurt these with Adsons). Splinting with pediatric hand therapy will be important in the post operative period.

This technique is valuable to have in your armamentarium (along knowing centralization or radialization procedures) helping optimize wrist alignment, soft tissue balance, and long-term functional outcomes.

#PediatricHandSurgery #RadialLongitudinalDeficiency #BilobeFlap #CongenitalHand

Bilobe Flap with Soft Tissue Release for Radial Longitudinal Deficiency

In select cases of radial longitudinal deficiency. A bilobe flap (volar based hides a bit better) offers a powerful local option for local tissue rearrangement after soft tissue release of the tight radial sided structures. This surgery maintains wrist motion however does not get the extremity completely straight. Use silk sutures to help retract the flaps to maintain the blood supply (do not hurt these with Adsons). Splinting with pediatric hand therapy will be important in the post operative period.

This technique is valuable to have in your armamentarium (along knowing centralization or radialization procedures) helping optimize wrist alignment, soft tissue balance, and long-term functional outcomes.

#PediatricHandSurgery #RadialLongitudinalDeficiency #BilobeFlap #CongenitalHand

Pediatric hand surgery principles: The Z-plasty is an effective technique in pediatric hand reconstruction including amniotic bands and scar contractures. It is based on the principle that it is possible to stretch a scarred area with the interposition of two more triangular flaps rotated from immediately adjacent areas with maximum elongation. The central limb is typically centered over a contraction band or burn contracture scar, for the transposition of the flaps to result in a gain in length. A standard Z-plasty has angles of 60° with theoretical gain in length of 75%. A single Z-plasty or multiple are common in the webspace contractures. Four and five flap Z-plasties are common for webspace deepening.

Z-plasty tips:
 - Mark with a fine tip pen but feel free to remark as needed (erase with alcohol swabs) 
- Use a 15C or 67 blade for precision
 - You can see the theoretical gain in this illustration, the overlap of the original limb you are trying to lengthen  - Ensuring that there is laxity from where the flaps are rotating from 
- Elevate the flap completely from the base, these are random flaps so it’s a balance of not completely devascularizing the flap and mobilizing. Best to leave fat under the flaps, they should not be skin grafts but rather true flaps with composite tissue you are rotating. You want these to stay as flaps and no grafts (i.e. bad blood supply means incomplete healing and scarring which is besidesthe point).
 -Do not crush the flap (do not touch them with a crushing Adson), instead use a silk suture at the tip as a loop with small clamp to help retract (minimizing crushing of an Adson

- Sometimes a Z plasty may not be enough to correct the deformity and you have to be creatively to try to achieve a good outcome for the patient.

Anything else to add? 
#pediatrichandsurgery #amnioticbandsyndrome #zplasty

Pediatric hand surgery principles: The Z-plasty is an effective technique in pediatric hand reconstruction including amniotic bands and scar contractures. It is based on the principle that it is possible to stretch a scarred area with the interposition of two more triangular flaps rotated from immediately adjacent areas with maximum elongation. The central limb is typically centered over a contraction band or burn contracture scar, for the transposition of the flaps to result in a gain in length. A standard Z-plasty has angles of 60° with theoretical gain in length of 75%. A single Z-plasty or multiple are common in the webspace contractures. Four and five flap Z-plasties are common for webspace deepening.

Z-plasty tips:
 - Mark with a fine tip pen but feel free to remark as needed (erase with alcohol swabs) 
- Use a 15C or 67 blade for precision
 - You can see the theoretical gain in this illustration, the overlap of the original limb you are trying to lengthen  - Ensuring that there is laxity from where the flaps are rotating from 
- Elevate the flap completely from the base, these are random flaps so it’s a balance of not completely devascularizing the flap and mobilizing. Best to leave fat under the flaps, they should not be skin grafts but rather true flaps with composite tissue you are rotating. You want these to stay as flaps and no grafts (i.e. bad blood supply means incomplete healing and scarring which is besidesthe point).
 -Do not crush the flap (do not touch them with a crushing Adson), instead use a silk suture at the tip as a loop with small clamp to help retract (minimizing crushing of an Adson

- Sometimes a Z plasty may not be enough to correct the deformity and you have to be creatively to try to achieve a good outcome for the patient.

Anything else to add? 
#pediatrichandsurgery #amnioticbandsyndrome #zplasty

You gotta know this one! 🚨 Greig Cephalopolysyndactyly Syndrome (GCPS)
A congenital difference (1–9 per 1,000,000) linked to loss-of-function mutations in GLI3.

Primary findings: Hypertelorism, macrocephaly with frontal bossing, significant polysyndactyly of hands and feet

Hands/Feet: Polydactyly more common in the feet, postaxial in the hands; variable cutaneous syndactyly, can be symmetrical
Thumbs: Broad and characteristic in many cases, Great toes can also be fully duplicated

Recognition is key for early diagnosis, multidisciplinary care, and genetic testing and counseling. Many times pediatric hand surgeons will be the first to provide a suspected clinical diagnosis.

This patient has 9 distal phalanges in one hand (floating, secret one in third webspace syndactyly and 3 thumbs distal phalanges)! Staged surgeries is key. First staged included thumb reconstruction and first webspace, floating polydactyl excision. Second stage was third web spaces. You don’t go after removing extra phalanges unless too bulky.. you want to avoid making nail bed injuries. Clinodactyly of index with left side was also corrected (hard to see on these photos). Patient fortunately did well and functional.

#PediatricHandSurgery #Syndactyly #greigcephalopolysyndactyly #Polydactyly #GLI3 #HandSurgeryEducation

You gotta know this one! 🚨 Greig Cephalopolysyndactyly Syndrome (GCPS)
A congenital difference (1–9 per 1,000,000) linked to loss-of-function mutations in GLI3.

Primary findings: Hypertelorism, macrocephaly with frontal bossing, significant polysyndactyly of hands and feet

Hands/Feet: Polydactyly more common in the feet, postaxial in the hands; variable cutaneous syndactyly, can be symmetrical
Thumbs: Broad and characteristic in many cases, Great toes can also be fully duplicated

Recognition is key for early diagnosis, multidisciplinary care, and genetic testing and counseling. Many times pediatric hand surgeons will be the first to provide a suspected clinical diagnosis.

This patient has 9 distal phalanges in one hand (floating, secret one in third webspace syndactyly and 3 thumbs distal phalanges)! Staged surgeries is key. First staged included thumb reconstruction and first webspace, floating polydactyl excision. Second stage was third web spaces. You don’t go after removing extra phalanges unless too bulky.. you want to avoid making nail bed injuries. Clinodactyly of index with left side was also corrected (hard to see on these photos). Patient fortunately did well and functional.

#PediatricHandSurgery #Syndactyly #greigcephalopolysyndactyly #Polydactyly #GLI3 #HandSurgeryEducation

Can you name the diagnosis? 🤔Be specific!

How many “digits” can you count in this X-ray?

Forward to a friend to ask them if you don’t know! Bookmark this!

#pediatrichandsurgery

Can you name the diagnosis? 🤔Be specific!

How many “digits” can you count in this X-ray?

Forward to a friend to ask them if you don’t know! Bookmark this!

#pediatrichandsurgery

Radioulnar Synostosis!

Radioulnar synostosis is a congenital difference where the radius and ulna are fused proximally, preventing normal forearm rotation. Several types exist, ranging from fibrous to bony fusion, sometimes associated with congenital syndromes such as Antley–Bixler syndrome.

Key points:
• Most cases do NOT require surgery, as children adapt surprisingly well.
• Surgical options are limited, and outcomes often unpredictable.
• This remains an unsolved problem in pediatric hand surgery, rooted in a developmental difference during embryogenesis around weeks 7–8 of gestation, when the forearm normally separates. Because it was initially made this way we as surgeons are very limited in how we can help.

For most patients, we recommend simple observation. For those where the hands sit in hyperpronation where they have difficulty putting their hands on their laps or bringing their hands together, then surgery may be helpful. The world we live in is based on phones and iPads, so it’s best to have the hands in slight pronation.

#PediatricHandSurgery #RadioulnarSynostosis #CongenitalHand #Pediatrichandytherapy

Radioulnar Synostosis!

Radioulnar synostosis is a congenital difference where the radius and ulna are fused proximally, preventing normal forearm rotation. Several types exist, ranging from fibrous to bony fusion, sometimes associated with congenital syndromes such as Antley–Bixler syndrome.

Key points:
• Most cases do NOT require surgery, as children adapt surprisingly well.
• Surgical options are limited, and outcomes often unpredictable.
• This remains an unsolved problem in pediatric hand surgery, rooted in a developmental difference during embryogenesis around weeks 7–8 of gestation, when the forearm normally separates. Because it was initially made this way we as surgeons are very limited in how we can help.

For most patients, we recommend simple observation. For those where the hands sit in hyperpronation where they have difficulty putting their hands on their laps or bringing their hands together, then surgery may be helpful. The world we live in is based on phones and iPads, so it’s best to have the hands in slight pronation.

#PediatricHandSurgery #RadioulnarSynostosis #CongenitalHand #Pediatrichandytherapy

Radioulnar Synostosis!

Radioulnar synostosis is a congenital difference where the radius and ulna are fused proximally, preventing normal forearm rotation. Several types exist, ranging from fibrous to bony fusion, sometimes associated with congenital syndromes such as Antley–Bixler syndrome.

Key points:
• Most cases do NOT require surgery, as children adapt surprisingly well.
• Surgical options are limited, and outcomes often unpredictable.
• This remains an unsolved problem in pediatric hand surgery, rooted in a developmental difference during embryogenesis around weeks 7–8 of gestation, when the forearm normally separates. Because it was initially made this way we as surgeons are very limited in how we can help.

For most patients, we recommend simple observation. For those where the hands sit in hyperpronation where they have difficulty putting their hands on their laps or bringing their hands together, then surgery may be helpful. The world we live in is based on phones and iPads, so it’s best to have the hands in slight pronation.

#PediatricHandSurgery #RadioulnarSynostosis #CongenitalHand #Pediatrichandytherapy

Radioulnar Synostosis!

Radioulnar synostosis is a congenital difference where the radius and ulna are fused proximally, preventing normal forearm rotation. Several types exist, ranging from fibrous to bony fusion, sometimes associated with congenital syndromes such as Antley–Bixler syndrome.

Key points:
• Most cases do NOT require surgery, as children adapt surprisingly well.
• Surgical options are limited, and outcomes often unpredictable.
• This remains an unsolved problem in pediatric hand surgery, rooted in a developmental difference during embryogenesis around weeks 7–8 of gestation, when the forearm normally separates. Because it was initially made this way we as surgeons are very limited in how we can help.

For most patients, we recommend simple observation. For those where the hands sit in hyperpronation where they have difficulty putting their hands on their laps or bringing their hands together, then surgery may be helpful. The world we live in is based on phones and iPads, so it’s best to have the hands in slight pronation.

#PediatricHandSurgery #RadioulnarSynostosis #CongenitalHand #Pediatrichandytherapy

Say no to hyperpronation. For select pediatric cases of radioulnar synostosis, a rotational osteotomy can be performed while preserving the periosteum (typical age of 5 years old). A 1 cm segment of bone is resected then moralized, replaced into its native sleeve and then it’s rotated to its no position (slight pronation) —allowing biologic stabilization without hardware.
• Periosteum intact → biologic scaffold for healing
• Segmental osteotomy → facilitates mobilization & correction
• Fasciotomies are performed prophylactically always, always cut the cast to allow for swelling
• Overnight admission → for close observation of compartment syndrome
• No hardware just casting → avoids long-term implant complications in children

This hardware-free approach emphasizes safety, simplicity, and natural healing potential. Parents of course have to watch the patient closely during healing (casting for at least 6 weeks).

#PediatricHandSurgery #Osteotomy #CongenitalHand #Orthopaedics #HandSurgeryEducation #radioulnarsynostosis

Say no to hyperpronation. For select pediatric cases of radioulnar synostosis, a rotational osteotomy can be performed while preserving the periosteum (typical age of 5 years old). A 1 cm segment of bone is resected then moralized, replaced into its native sleeve and then it’s rotated to its no position (slight pronation) —allowing biologic stabilization without hardware.
• Periosteum intact → biologic scaffold for healing
• Segmental osteotomy → facilitates mobilization & correction
• Fasciotomies are performed prophylactically always, always cut the cast to allow for swelling
• Overnight admission → for close observation of compartment syndrome
• No hardware just casting → avoids long-term implant complications in children

This hardware-free approach emphasizes safety, simplicity, and natural healing potential. Parents of course have to watch the patient closely during healing (casting for at least 6 weeks).

#PediatricHandSurgery #Osteotomy #CongenitalHand #Orthopaedics #HandSurgeryEducation #radioulnarsynostosis

Principles: Photos and Video

Always ask permission to record and formalize a way to have consent. Make sure to take videos of hand function in children and adolescents. Have them do age appropriate tasks. Have them use pens. Have them use toys. Have them work with Pediatric Hand Therapists. Have them use a phone. Have them put their hands flat on their laps and bring their hands together. If you are correcting a deformity show it in action (for example distal radioulnar joint instability).

Use a good background and color that contrasts well (blue or green are great colors). Try to keep the color consistent if possible. Consider using a professional camera with a macro lens.

Take photos before surgery, during the surgery and after. Take all the relevant views (volar, lateral, and dorsal views). Take photos of function including a thumbs up Take photos over the long term. You will see and learn so much about the eventual outcome. You will not regret taking photos of your patients over time. Photos can be looked at before the next stage of surgery and provides so much information for recalling relevant information. You will be able to show your results not only for yourself, for others and patients interested in similar surgery.

#pediatrichandsurgery #polydactyly #PolydactylytTypeA

Principles: Photos and Video

Always ask permission to record and formalize a way to have consent. Make sure to take videos of hand function in children and adolescents. Have them do age appropriate tasks. Have them use pens. Have them use toys. Have them work with Pediatric Hand Therapists. Have them use a phone. Have them put their hands flat on their laps and bring their hands together. If you are correcting a deformity show it in action (for example distal radioulnar joint instability).

Use a good background and color that contrasts well (blue or green are great colors). Try to keep the color consistent if possible. Consider using a professional camera with a macro lens.

Take photos before surgery, during the surgery and after. Take all the relevant views (volar, lateral, and dorsal views). Take photos of function including a thumbs up Take photos over the long term. You will see and learn so much about the eventual outcome. You will not regret taking photos of your patients over time. Photos can be looked at before the next stage of surgery and provides so much information for recalling relevant information. You will be able to show your results not only for yourself, for others and patients interested in similar surgery.

#pediatrichandsurgery #polydactyly #PolydactylytTypeA

Dye your 5-0 or 6-0 plain gut or vicryl rapide sutures! 👀 A simple technique can change how you feel about using this type of suture. It makes it a lot easier to see when you have a lot of sutures to place and with wearing loupes. It also allows your assistant to see the suture easier to cut. #pediatrichandsurgery #suture

Dye your 5-0 or 6-0 plain gut or vicryl rapide sutures! 👀 A simple technique can change how you feel about using this type of suture. It makes it a lot easier to see when you have a lot of sutures to place and with wearing loupes. It also allows your assistant to see the suture easier to cut. #pediatrichandsurgery #suture

In children with amniotic band syndrome, first webspace contractures can significantly impact hand function and are our top priority to get their thumb back in action. Acrosyndactyly - fusion of the distal tips of the digits results in hypoplasia and restore a first webspace contracture release AND reconstruction is indicated. The Abdel-Ghani type flap offers an elegant option— allowing dorsal tissue to advance and rotate a flap into this space! Make sure to do a full release of facial structure of the first webspace and almost always it’s a good idea to place a K wire to hold the space as it heals. Cast for 4-5 weeks! Hand therapy is essential after to maintain this new space. The flap mentioned here is a bit small and free to make it larger as needed for the deficiency!

#PediatricHandSurgery #AmnioticBandSyndrome #HandSurgery #Reconstruction #FirstWebspace

In children with amniotic band syndrome, first webspace contractures can significantly impact hand function and are our top priority to get their thumb back in action. Acrosyndactyly - fusion of the distal tips of the digits results in hypoplasia and restore a first webspace contracture release AND reconstruction is indicated. The Abdel-Ghani type flap offers an elegant option— allowing dorsal tissue to advance and rotate a flap into this space! Make sure to do a full release of facial structure of the first webspace and almost always it’s a good idea to place a K wire to hold the space as it heals. Cast for 4-5 weeks! Hand therapy is essential after to maintain this new space. The flap mentioned here is a bit small and free to make it larger as needed for the deficiency!

#PediatricHandSurgery #AmnioticBandSyndrome #HandSurgery #Reconstruction #FirstWebspace

Simple syndactyly is simple..
except it takes hours! One approach is to use full thickness skin grafts, which you can easily get from the volar wrist, antecubital fossa and medial forearm. No need for a groin skin grafts! You can keep it all in one area usually. From the medial forearm (draw a line from the ulnar styloid to the medial epicondyle to avoid hair with good color match) and you can re-harvest during a second stage surgery too. All suture used should be absorbable.

The goal is to create a robust dorsal flap for the commissure to avoid webcreep. The goal is also to avoid any type of wound care after the surgery and leave it exactly as you repaired it. Every suture you place will allow it to heal in an ideal position and if you do a good job, then it will heal well. The tissue will want to heal immediately and so wound care is typically not necessary if you apply dressing with a lot of ointment and into a long arm club cast. Leave this cast on for four weeks. Tell the families to keep the cast clean, dry, elevated, keep the child inside, and full-time supervision. The goal is to not have the child come in for wound care because it will be painful for the child, painful for the parent, painful for the clinic staff, and painful for you. Instead, take the time to do a good dressing and cast and give it the space for it to heal over four weeks in a cast.

Any other tips to provide a reliable result?

#pediatrichandsurgery #syndactyly

Simple syndactyly is simple..
except it takes hours! One approach is to use full thickness skin grafts, which you can easily get from the volar wrist, antecubital fossa and medial forearm. No need for a groin skin grafts! You can keep it all in one area usually. From the medial forearm (draw a line from the ulnar styloid to the medial epicondyle to avoid hair with good color match) and you can re-harvest during a second stage surgery too. All suture used should be absorbable.

The goal is to create a robust dorsal flap for the commissure to avoid webcreep. The goal is also to avoid any type of wound care after the surgery and leave it exactly as you repaired it. Every suture you place will allow it to heal in an ideal position and if you do a good job, then it will heal well. The tissue will want to heal immediately and so wound care is typically not necessary if you apply dressing with a lot of ointment and into a long arm club cast. Leave this cast on for four weeks. Tell the families to keep the cast clean, dry, elevated, keep the child inside, and full-time supervision. The goal is to not have the child come in for wound care because it will be painful for the child, painful for the parent, painful for the clinic staff, and painful for you. Instead, take the time to do a good dressing and cast and give it the space for it to heal over four weeks in a cast.

Any other tips to provide a reliable result?

#pediatrichandsurgery #syndactyly

Thumb polydactyly is a common condition that we treat. This condition happens at random however can be genetic, especially if it’s a triphalangeal type.

One should always consider the deformity and especially in cases where it’s multilevel. For example, here the carpometacarpal joint was reconstructed and pinned, the ulnar collateral ligament was reconstructed with a tendon graft (spare part) and a suture button to help hold part of it through bone (pinned too), finally a four flap Z plasty for the webspace. Our goal is always to get as much done as we can in a single stage surgery in a safe way. In patients with thumb polydactyly we should always tell the families that there’s a risk of more surgery as they grow. However, if you address all components of the deformity, for example, in this case, the ulnar collateral ligament and create it so that it is stable.. the hope is that no additional surgery is needed. If you look at the x-ray, the thumb is now clinically straight after the surgery compared to the significant deformity prior. Also, if it’s complex, it’s always OK to let the child grow so that the tissue may be easier to work with to provide a reliable result.

#pediatrichandsurgery #pediatricorthopaedics #thumbpolydactyly #polydactyly

Thumb polydactyly is a common condition that we treat. This condition happens at random however can be genetic, especially if it’s a triphalangeal type.

One should always consider the deformity and especially in cases where it’s multilevel. For example, here the carpometacarpal joint was reconstructed and pinned, the ulnar collateral ligament was reconstructed with a tendon graft (spare part) and a suture button to help hold part of it through bone (pinned too), finally a four flap Z plasty for the webspace. Our goal is always to get as much done as we can in a single stage surgery in a safe way. In patients with thumb polydactyly we should always tell the families that there’s a risk of more surgery as they grow. However, if you address all components of the deformity, for example, in this case, the ulnar collateral ligament and create it so that it is stable.. the hope is that no additional surgery is needed. If you look at the x-ray, the thumb is now clinically straight after the surgery compared to the significant deformity prior. Also, if it’s complex, it’s always OK to let the child grow so that the tissue may be easier to work with to provide a reliable result.

#pediatrichandsurgery #pediatricorthopaedics #thumbpolydactyly #polydactyly

In amniotic band syndrome, a straight-line release approach can be aesthetically pleasing after reconstruction. This approach allows complete exposure of the constricting band, improves contour, and minimizes scar irregularity.

The principles include removing all of the constricted skin and your circumferential incision can be mirrored to the other aspect of the amnionic band. A fasciotomy becomes important with protecting the underlying neurovascular structures.

Closure is done in layers—including deeper fat—before aligning skin edges, which reduces tension and prevents contour irregularities.

Thoughtful incision planning, full release and layered closure are key. We can all agree when patients come back and the family tells us that no one notices a difference anymore —> that really is our goal! What is your preferred approach?

#PediatricHandSurgery #AmnionicBandSyndrome

In amniotic band syndrome, a straight-line release approach can be aesthetically pleasing after reconstruction. This approach allows complete exposure of the constricting band, improves contour, and minimizes scar irregularity.

The principles include removing all of the constricted skin and your circumferential incision can be mirrored to the other aspect of the amnionic band. A fasciotomy becomes important with protecting the underlying neurovascular structures.

Closure is done in layers—including deeper fat—before aligning skin edges, which reduces tension and prevents contour irregularities.

Thoughtful incision planning, full release and layered closure are key. We can all agree when patients come back and the family tells us that no one notices a difference anymore —> that really is our goal! What is your preferred approach?

#PediatricHandSurgery #AmnionicBandSyndrome

Madelung deformity represents a complex spectrum of presentation. In patients with Leri-Weil dyschondrosteosis this can hereditary with mesomelia. Make sure to ask about siblings so you can intervene earlier if needed with vickers ligament release and physiolysis. A dome osteotomy with ulnar shortening can provide meaningful correction in select cases. When there is a multiplane deformity, you can consider 3-D planning. These are challenging differences that we want to minimize the amount of surgery they need, and in the long-term, they are always at risk of developing earlier distal radioulnar arthritis.

#PediatricHandSurgery #MadelungDeformity #CongenitalHand #OrthopedicSurgery #HandSurgery #PediatricOrthopedics

Madelung deformity represents a complex spectrum of presentation. In patients with Leri-Weil dyschondrosteosis this can hereditary with mesomelia. Make sure to ask about siblings so you can intervene earlier if needed with vickers ligament release and physiolysis. A dome osteotomy with ulnar shortening can provide meaningful correction in select cases. When there is a multiplane deformity, you can consider 3-D planning. These are challenging differences that we want to minimize the amount of surgery they need, and in the long-term, they are always at risk of developing earlier distal radioulnar arthritis.

#PediatricHandSurgery #MadelungDeformity #CongenitalHand #OrthopedicSurgery #HandSurgery #PediatricOrthopedics

Madelung deformity is not one condition, but a spectrum. Each child’s wrist can look and function very differently, making treatment complex. In severe cases, 3D planning helps us see the deformity in all dimensions and design precise, patient-specific corrections.

Mild cases may involve only subtle changes in distal radial inclination or minor ulnar-positive variance, often detected incidentally.

Moderate cases demonstrate more obvious wrist deformity, pain, and functional limitation, with bowing of the distal radius and prominence of the distal ulna.

Severe cases can present with profound wrist malalignment, abnormal DRUJ mechanics, pain with pronation–supination, and functional compromise in children or adolescents.

This variability arises from the interplay between growth disturbance of the distal radial physis, tethering of the volar ulnar physis (Vickers ligament), and the compensatory changes in the distal ulna and carpus. Because the deformity progresses with growth, timing of intervention adds another layer of complexity.

#madelung #madelungdeformity #3D Planning

Madelung deformity is not one condition, but a spectrum. Each child’s wrist can look and function very differently, making treatment complex. In severe cases, 3D planning helps us see the deformity in all dimensions and design precise, patient-specific corrections.

Mild cases may involve only subtle changes in distal radial inclination or minor ulnar-positive variance, often detected incidentally.

Moderate cases demonstrate more obvious wrist deformity, pain, and functional limitation, with bowing of the distal radius and prominence of the distal ulna.

Severe cases can present with profound wrist malalignment, abnormal DRUJ mechanics, pain with pronation–supination, and functional compromise in children or adolescents.

This variability arises from the interplay between growth disturbance of the distal radial physis, tethering of the volar ulnar physis (Vickers ligament), and the compensatory changes in the distal ulna and carpus. Because the deformity progresses with growth, timing of intervention adds another layer of complexity.

#madelung #madelungdeformity #3D Planning

Correcting bony deformity requires precision. Simply excising a polydactyly can be inadequate in the setting of bony and joint deformities. The goal is to have correction that avoids impingement, and allows a more typical positioning. One approach for a corrective ostomy is to place a distal pin first, perform the osteotomy, reduce the fragments, and then simply drive the pin across the fracture site. Having a step wise approach, allows for precision with less manipulation of the tissues. Less manipulation will always result in quicker healing, because the underlying blood supply is minimally affected. Finally protect your periosteum so that after the osteotomy is performed, the periosteum can be easily repaired to allow for even more robust healing.

#pediatrichand #pediatrichandsurgery

Correcting bony deformity requires precision. Simply excising a polydactyly can be inadequate in the setting of bony and joint deformities. The goal is to have correction that avoids impingement, and allows a more typical positioning. One approach for a corrective ostomy is to place a distal pin first, perform the osteotomy, reduce the fragments, and then simply drive the pin across the fracture site. Having a step wise approach, allows for precision with less manipulation of the tissues. Less manipulation will always result in quicker healing, because the underlying blood supply is minimally affected. Finally protect your periosteum so that after the osteotomy is performed, the periosteum can be easily repaired to allow for even more robust healing.

#pediatrichand #pediatrichandsurgery

PEDIATRIC NERVE LESIONS - November, 21th-22th, 2025 - León, Spain

SPEAKERS
Dr. M. Llusa
Dr. S. Tuffaha
Dr. J. Bahm
Dr. M. Socolovsky
Dr. A. Gilbert
Dr. K. Casanas
Dr. A. Lovic
Dr. D. Zlotolow
Dr. E. Devinney
Dr. S. Ferraresi
Dra. E. Basso
Dr. O. Merced O’Neill
Dr. F. Guedes
Dr. L. Rasulic
Dr. R. Gepp

linked to the program: https://shorturl.at/yOMjV

#medicine #surgery #plasticsurgery #orthopedicsurgery #orthopedic #handsurgery #congenitalhandsurgery #pediatrichandsurgery

PEDIATRIC NERVE LESIONS - November, 21th-22th, 2025 - León, Spain

SPEAKERS
Dr. M. Llusa
Dr. S. Tuffaha
Dr. J. Bahm
Dr. M. Socolovsky
Dr. A. Gilbert
Dr. K. Casanas
Dr. A. Lovic
Dr. D. Zlotolow
Dr. E. Devinney
Dr. S. Ferraresi
Dra. E. Basso
Dr. O. Merced O’Neill
Dr. F. Guedes
Dr. L. Rasulic
Dr. R. Gepp

linked to the program: https://shorturl.at/yOMjV

#medicine #surgery #plasticsurgery #orthopedicsurgery #orthopedic #handsurgery #congenitalhandsurgery #pediatrichandsurgery

Join @handtherapyasht for Pediatric Specialty Day!
Delve into the Intricacies of Pediatric Hand Therapy

Join us Wednesday, October 22 from 8 a.m. to 5 p.m. on a journey beyond the fundamentals. This specialized course promises an exploration of unique diagnoses, innovative treatments and the myriad triumphs and challenges inherent in the realm of pediatric hand therapy.

Whether you’re a seasoned practitioner seeking to deepen your expertise or a newcomer eager to expand your knowledge, Pediatric Specialty Day is your gateway to a comprehensive understanding of the evolving landscape of pediatric hand therapy.

Pediatric Specialty Day will be held as a full day of programming the day before the start of the ASHT Annual Meeting. Registration will be available for purchase on its own or as an add-on to the full conference package. A maximum of 6.5 CE hours is available.

Join @handtherapyasht for Pediatric Specialty Day!
Delve into the Intricacies of Pediatric Hand Therapy

Join us Wednesday, October 22 from 8 a.m. to 5 p.m. on a journey beyond the fundamentals. This specialized course promises an exploration of unique diagnoses, innovative treatments and the myriad triumphs and challenges inherent in the realm of pediatric hand therapy.

Whether you’re a seasoned practitioner seeking to deepen your expertise or a newcomer eager to expand your knowledge, Pediatric Specialty Day is your gateway to a comprehensive understanding of the evolving landscape of pediatric hand therapy.

Pediatric Specialty Day will be held as a full day of programming the day before the start of the ASHT Annual Meeting. Registration will be available for purchase on its own or as an add-on to the full conference package. A maximum of 6.5 CE hours is available.

Very cool to see advertisement for Pediatric Hand Surgery as its own dedicated field! #pediatrichandsurgery

Very cool to see advertisement for Pediatric Hand Surgery as its own dedicated field! #pediatrichandsurgery

Join the Global Pediatric Hand Surgery Community!
Ganga Hospital presents the 13th World Symposium on Congenital Malformations of the Hand and Upper Limb 2026 — a premier event bringing together experts from around the world to share innovations, techniques, and experiences in congenital hand surgery.

Save the Dates:
February 25–28, 2026
Location: Ganga Hospital, Coimbatore, India

An unmissable opportunity for surgeons, therapists, trainees, and researchers in pediatric and congenital upper limb care.

Organizing Chairman: Dr. S Raja Sabapathy
Organizing Secretary: Dr. Monusha Mohan

Online Registration Now Open!
Early Bird Registration till : 31st Oct 2025
Standard Registration till : 31st Dec 2025
Late Registration till : 31st Jan 2026
Abstract submission will be updated soon
Website: wcs2026.com

#HandSurgery #PediatricHandSurgery #PediatricHand #WSCMHUL2026 #CongenitalHand #GlobalSurgery #GangaHospital

Join the Global Pediatric Hand Surgery Community!
Ganga Hospital presents the 13th World Symposium on Congenital Malformations of the Hand and Upper Limb 2026 — a premier event bringing together experts from around the world to share innovations, techniques, and experiences in congenital hand surgery.

Save the Dates:
February 25–28, 2026
Location: Ganga Hospital, Coimbatore, India

An unmissable opportunity for surgeons, therapists, trainees, and researchers in pediatric and congenital upper limb care.

Organizing Chairman: Dr. S Raja Sabapathy
Organizing Secretary: Dr. Monusha Mohan

Online Registration Now Open!
Early Bird Registration till : 31st Oct 2025
Standard Registration till : 31st Dec 2025
Late Registration till : 31st Jan 2026
Abstract submission will be updated soon
Website: wcs2026.com

#HandSurgery #PediatricHandSurgery #PediatricHand #WSCMHUL2026 #CongenitalHand #GlobalSurgery #GangaHospital

#Repost @drjaneshen
・・・
2025 Symposium

Congenital Malformations of the Extremities

Lectures & 3-day Live Broadcast Surgeries

Children’s Hospital of Soochow University

Registration opening soon !!

Contact: jypx3505@1 26.com

#Repost @drjaneshen
・・・
2025 Symposium

Congenital Malformations of the Extremities

Lectures & 3-day Live Broadcast Surgeries

Children’s Hospital of Soochow University

Registration opening soon !!

Contact: jypx3505@1 26.com

Link for the course in our stories. #pediatrichandsurgery

Link for the course in our stories. #pediatrichandsurgery

@pediatric_hand_study_group annual meeting at Children’s Hospital Los Angeles!

@pediatric_hand_study_group annual meeting at Children’s Hospital Los Angeles!

Crush finger tip injuries are frequently seen in a Pediatric Hand Surgery practice. Many are repaired at other facilities. The main known unknown is that no one knows what is going on underneath the nail plate after these injuries. When there is a subungual hematoma, you can presume that there is likely is a nailbed laceration. How big that laceration no one knows unless the nail plate is removed (no percent cut off that is certain). Removing the nail plate initially (especially if mostly avulsed) is likely the best option for patients to ensure that any fracture (if there) is irrigated and repaired. There are many instances where there may not be an acute fracture. However, if there is a big enough laceration that does not heal primarily and instead may turn into a pyogenic granuloma. Pyogenic granulomas can be treated with silver nitrate, which is a chemical type of burn to the overgrown tissue. Another option is surgical excision. Typically silver nitrate is able to treat these quite well. If there’s ever any fluid coming out from underneath the nail plate and there’s a history of previous trauma, most likely there is an underlying undiagnosed pyogenic granuloma that has developed. In those instances where the patient presents delayed after an injury and there’s fluid coming out underneath the nail, they may need a more formal procedure to remove the nail, and either treat the pyogenic granuloma with silver nitrate or to surgically excise it. These are weekly conundrums that anyone who takes care of children and even adult adults will see and every case is different because every injury and mechanism and tissue size of the patient is different. In this case, the patient was treated with silver nitrate, and the nail grew in quite well.

What is your approach?

#pediatrichandsurgery #handsurgery #pyogenicgranuloma

Crush finger tip injuries are frequently seen in a Pediatric Hand Surgery practice. Many are repaired at other facilities. The main known unknown is that no one knows what is going on underneath the nail plate after these injuries. When there is a subungual hematoma, you can presume that there is likely is a nailbed laceration. How big that laceration no one knows unless the nail plate is removed (no percent cut off that is certain). Removing the nail plate initially (especially if mostly avulsed) is likely the best option for patients to ensure that any fracture (if there) is irrigated and repaired. There are many instances where there may not be an acute fracture. However, if there is a big enough laceration that does not heal primarily and instead may turn into a pyogenic granuloma. Pyogenic granulomas can be treated with silver nitrate, which is a chemical type of burn to the overgrown tissue. Another option is surgical excision. Typically silver nitrate is able to treat these quite well. If there’s ever any fluid coming out from underneath the nail plate and there’s a history of previous trauma, most likely there is an underlying undiagnosed pyogenic granuloma that has developed. In those instances where the patient presents delayed after an injury and there’s fluid coming out underneath the nail, they may need a more formal procedure to remove the nail, and either treat the pyogenic granuloma with silver nitrate or to surgically excise it. These are weekly conundrums that anyone who takes care of children and even adult adults will see and every case is different because every injury and mechanism and tissue size of the patient is different. In this case, the patient was treated with silver nitrate, and the nail grew in quite well.

What is your approach?

#pediatrichandsurgery #handsurgery #pyogenicgranuloma

Giant cell tumors of tendon sheath are very common in children. An MRI is incredibly helpful to delineate where the mass is and it can frequently invade other aspects of the digit including the joint. To excise these masses and avoid recurrence - perform a marginal excision with loupe magnification. Follow up is essential for these patients because recurrence can occur! #pediatrichandsurgery #handsurgery

Giant cell tumors of tendon sheath are very common in children. An MRI is incredibly helpful to delineate where the mass is and it can frequently invade other aspects of the digit including the joint. To excise these masses and avoid recurrence - perform a marginal excision with loupe magnification. Follow up is essential for these patients because recurrence can occur! #pediatrichandsurgery #handsurgery

The hypothenar area between the glaborous and nonglaborous skin is a fantastic place to obtain full thickness skin graft. It can even be re-harvested after a period of time. It has excellent match with the digits!

Wish we could suture this fast!!

5-0 monocryl deep dermal
5-0 plain running (dyed with marking pen)

#pediatrichandsurgery #handsurgery

The hypothenar area between the glaborous and nonglaborous skin is a fantastic place to obtain full thickness skin graft. It can even be re-harvested after a period of time. It has excellent match with the digits!

Wish we could suture this fast!!

5-0 monocryl deep dermal
5-0 plain running (dyed with marking pen)

#pediatrichandsurgery #handsurgery

Nerve Procedures for Spasticity.

Mark your calendars for a trip to Barcelona in May 2025! Chaired by @alainlaurentgilbert & @dr.caroline.leclercq , join in sharing experiences, tips and results about new modalities in neurotomies, nerve transfers, nerve reset neurorrhaphy, and more.

#nerve #neurotomy #nervetransfersurgeries #nervetransferupperlimb #orthopedicsurgery #plasticsurgery

Nerve Procedures for Spasticity.

Mark your calendars for a trip to Barcelona in May 2025! Chaired by @alainlaurentgilbert & @dr.caroline.leclercq , join in sharing experiences, tips and results about new modalities in neurotomies, nerve transfers, nerve reset neurorrhaphy, and more.

#nerve #neurotomy #nervetransfersurgeries #nervetransferupperlimb #orthopedicsurgery #plasticsurgery

Coming soon in October hosted by the Children’s Hospital of Soochow University - Check out the 1st international seminar on congenital hand surgery!

#handsurgery #congenitalhand #orthopedics #plasticsurgery #congenitalhandsurgery #medicine

Coming soon in October hosted by the Children’s Hospital of Soochow University - Check out the 1st international seminar on congenital hand surgery!

#handsurgery #congenitalhand #orthopedics #plasticsurgery #congenitalhandsurgery #medicine

“The World Understandings for Thumb Hypoplasia”
Special Issue for the Journal of Hand and Microsurgery ( indexed in PubMed, Scopus, Impact Factor)

🌟 Guest Editor: Prof. Dr.Takehiko Takagi, Japan
🌟 Editor-in-Chief: Dr. J. Terrence Jose Jerome, India

Join us for an exclusive exploration of congenital hand surgery! This special issue will feature:

✨ Original Articles
✨ Surgical Techniques
✨ Systematic Reviews
✨ Global Practices of congenital hand

Submit your contributions and be part of this groundbreaking issue. Together, let’s elevate the practice of worldwide congenital hand surgery!

#congenitalhand #Handsurgery #Journalofhandandmicrosurgery#elsevier#specialissue

“The World Understandings for Thumb Hypoplasia”
Special Issue for the Journal of Hand and Microsurgery ( indexed in PubMed, Scopus, Impact Factor)

🌟 Guest Editor: Prof. Dr.Takehiko Takagi, Japan
🌟 Editor-in-Chief: Dr. J. Terrence Jose Jerome, India

Join us for an exclusive exploration of congenital hand surgery! This special issue will feature:

✨ Original Articles
✨ Surgical Techniques
✨ Systematic Reviews
✨ Global Practices of congenital hand

Submit your contributions and be part of this groundbreaking issue. Together, let’s elevate the practice of worldwide congenital hand surgery!

#congenitalhand #Handsurgery #Journalofhandandmicrosurgery#elsevier#specialissue

New textbook alert! Link in stories! Edited by Giorgio Pajardi from Milan, Italy.

#medicine #surgery #plasticsurgery #orthopedicsurgery #orthopedic #handsurgery #congenitalhandsurgery #pediatrichandsurgery

New textbook alert! Link in stories! Edited by Giorgio Pajardi from Milan, Italy.

#medicine #surgery #plasticsurgery #orthopedicsurgery #orthopedic #handsurgery #congenitalhandsurgery #pediatrichandsurgery

Link in stories for details for the 2024 PHSG Conference @bostonchildrens

#medicine #surgery #plasticsurgery #orthopedicsurgery #orthopedic #handsurgery #congenitalhandsurgery #pediatrichandsurgery #pediatrichandstudygroup

Link in stories for details for the 2024 PHSG Conference @bostonchildrens

#medicine #surgery #plasticsurgery #orthopedicsurgery #orthopedic #handsurgery #congenitalhandsurgery #pediatrichandsurgery #pediatrichandstudygroup

An updated list of Open Pediatric Hand Surgery positions across the United States. Please see the link in the stories from today! Special thanks to many that helped put this list together including the Pediatric Hand Study Group. Please let us know if you know of more! There is definitely a need for Pediatric Hand surgeons in the United States.

#medicine #surgery #plasticsurgery #orthopedicsurgery #orthopedic #handsurgery #congenitalhandsurgery #pediatrichandsurgery

An updated list of Open Pediatric Hand Surgery positions across the United States. Please see the link in the stories from today! Special thanks to many that helped put this list together including the Pediatric Hand Study Group. Please let us know if you know of more! There is definitely a need for Pediatric Hand surgeons in the United States.

#medicine #surgery #plasticsurgery #orthopedicsurgery #orthopedic #handsurgery #congenitalhandsurgery #pediatrichandsurgery

Don’t miss out on this first annual Washington University Peripheral Nerve Surgery course bringing together @washuplasticsurgery @washuortho @washuneurosurgery @washuhand

Link in QR code and stories

#handsurgery #handtherapy #hand #plasticsurgery #orthopedicsurgery #surgery #microsurgery #nervenerds #nervesurgery

Don’t miss out on this first annual Washington University Peripheral Nerve Surgery course bringing together @washuplasticsurgery @washuortho @washuneurosurgery @washuhand

Link in QR code and stories

#handsurgery #handtherapy #hand #plasticsurgery #orthopedicsurgery #surgery #microsurgery #nervenerds #nervesurgery

Hope to see many of you this week!

Hope to see many of you this week!

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