Experience is key in kids hand surgery to ensure excellent functional outcomes.

When your child has been born with a congenital hand difference or has injured themselves parents need to be reassured that the care they receive is world class and that the management of the hand problem is based around the considerations for the child and the family involved.

Christopher Coombs has been Chief of Hand and Microvascular Surgery at the Royal Children’s Hospital (RCH), Melbourne since 2003. He is now Chief of the department of Plastic and Maxillofacial Surgery at RCH. He was appointed a Clinical Associate Professor at the University of Melbourne in 2008 for his work in this field and a full Clinical Professor in 2016. Following completion of his plastic surgery training in Melbourne in 1992, he continued his training in the field paediatric hand surgery and microsurgery at Harvard University in Boston working with Joseph Upton, MD who is recognised as one of the world’s leading paediatric hand surgeons. On his return from Harvard University he helped establish the Melbourne Paediatric Hand Centre based at the Royal Children’s Hospital in Melbourne. This centre has become known as one of the elite centres for the management of children with hand conditions. It attracts patients from all over Australia and there are enquiries to the centre about children with hand problems from many parts of the world.

Most parents are commonly surprised following the birth of their child that they have a congenital hand difference. The majority of congenital hand issues are not diagnosed prenatally by ultrasound and this leaves parents in a difficult situation not knowing what the future holds for their newborn child. Children who are born with a congenital hand difference are not the same as adults who end up with a hand problem following an injury. New parents of children with congenital hand differences commonly try to imagine what it would be like having a particular type of congenital hand anomaly. These children have been born with their hand difference and will grow from day one with their particular hand and are able to develop patterns of function that will enable them to grow up to lead fulfilling and fruitful lives without significant impairment to their function.

The objective of surgery for congenital hand differences is to maximise function, completing surgical reconstructions as required usually by the time the child reaches school age.

Things to consider

Development of the limbs in a baby occurs very early, during the 3rd and 8th week of the pregnancy. There is an elaborate interplay between the cells of the developing limb and why there is an alteration in these processes that then results in a congenital hand difference is largely unknown. Some patients will have a family history of hand anomalies but the majority ‘just happen’.
There is no evidence that anything a mother does during pregnancy causes congenital hand defects.

A large study in America has shown that the incidence of congenital hand anomalies is 1 in 626 live births but regional and ethnic differences occur. The most common hand differences are camptodactyly (bent fingers), syndactyly (joined fingers) and polydactyly (extra digits). Occasionally congenital hand differences (5%) can be part of a broader underlying congenital syndrome.

At Southern Plastic Surgery we feel that giving information early helps alleviate anxiety that may accompany the diagnosis of a child with a congenital hand difference. This can happen prenatally by ultrasound or following the delivery of the newborn baby. We prefer to see parents as soon as possible following the diagnosis of a congenital hand difference in their child so that accurate information can be given and a program of management can be outlined for them.