Teamwork, technology give hope to kids with hand anomalies

Jan. 31, 2020

Mayo Clinic Children's Center in Rochester, Minnesota, is delivering hope to kids with congenital hand anomalies. Using a multidisciplinary approach along with sophisticated technology and groundbreaking clinical trials, specialists are able to address every aspect of care.

"The team brings broad experience with microsurgery, bone lengthening and straightening, free tissue transfer, and infant and pediatric prosthetics, which allows the best and most up-to-date care," says Steven L. Moran, M.D., a hand and plastic surgeon at Mayo Clinic Children's Center.

Pioneering advances in technology

Specialists at Mayo Clinic Children's Center established a grading system and outcomes scoring assessment for children with absent or underdeveloped thumbs. These tools are now widely used in the U.S. and in Europe. Mayo Clinic uses the most advanced technology with regard to bone lengthening, soft tissue reconstruction and prosthetic fabrication, including 3D imaging and reconstruction, to manage congenital hand anomalies. Micro-computerized tomography (micro-CT) imaging enables greatly increased resolution on a small scale. Using an image from a micro-CT scan, pediatric radiologists can create 3D models that can be saved for further analysis.

Congenital hand differences can now be identified during fetal ultrasound, and consultation with the hand surgeon is often performed before a baby is born. Surgical models are made from imaging studies of the child's fingers and arms, allowing surgeons the opportunity to plan and practice surgery.

Dr. Moran, who has championed the use of microsurgery for the treatment of underdeveloped bones, described pediatric microsurgery as a successful procedure in an article in the April 2017 issue of Clinics in Plastic Surgery. According to Dr. Moran, this surgery can provide immediate reconstruction results without the need for tissue expansion, skin grafting or muscle sacrifice.

He further explains that Mayo Clinic is working to identify problems that may be repaired in utero. "We are working with new modalities in regenerative medicine in hopes of being able to regrow or restore hands and fingers and identify those problems that may be fixed before the baby is born," says Dr. Moran.

Mayo Clinic is also participating in FDA trials of an anti-scar medication to help minimize external signs of surgery. "We take a multidisciplinary approach to manage congenital hand differences," says Nicholas A. Pulos, M.D., an orthopedic hand and microvascular surgeon at Mayo Clinic Children's Center. "As a team, we seek to provide the correct diagnosis to parents who are appropriately stressed and searching for answers in a single visit."

The treatment team includes two orthopedic hand and microvascular surgeons, as well as a pediatric orthopedic surgeon and a neurosurgeon specializing in peripheral nerve surgery.

Integrated care that follows children into adulthood

Long-term, integrated care at Mayo Clinic Children's Center enables a level of care and trust that helps patients feel comfortable with their hand differences as they grow through different stages and phases of life.

"Our approach is to address every aspect of care — from diagnosis to treatment to emotional support — so the family feels well taken care of," says Dr. Pulos. "What sets Mayo Clinic Children's Center apart is our ability to consistently see these children as they grow into adulthood."

Dr. Moran agrees, stating, "We are participating in a clinical trial regarding anti-scar medications. These medications could help children heal with minimal external signs of surgery."

Processes are put in place as children return to their primary care physician to ensure consistent treatment. But, as Dr. Pulos states, Mayo Clinic is just a phone call away. "When needed, all of our specialists are here on campus, so families can see the right people quickly." "The future is definitely bright for children with hand anomalies."

For more information

Izadpanah A, et al. Pediatric microsurgery: A global overview. Clinics in Plastic Surgery. 2017;44:313.