Central Ray Deficiency: Subjective and Objective Outcome of Cleft Reconstruction

PurposeTo assess the long-term subjective and objective outcome of cleft reconstruction in patients with central ray deficiency.MethodsTwelve patients with 16 central ray deficiency hands were included. Each hand had been treated with cleft reconstruction using soft tissue and/or bony procedures. A surgeon and parent assessed the subjective outcome using a visual analog scale to compare preoperative and postoperative appearance. Objective outcome was assessed with a clinical examination for digital range of motion and with a radiographic examination for preoperative and postoperative divergence angles of the index finger and ring finger metacarpals and phalanges.ResultsThe surgeon's visual analog scale score significantly increased from 4 to 7. Nine parents were very satisfied, 4 were satisfied, and 3 were somewhat satisfied with hand appearance. A ring finger proximal interphalangeal joint flexion contracture averaging 31° was the most notable clinical finding. The metacarpal divergence angle significantly improved from 33° to 12°, and the phalangeal divergence angle significantly improved from 38° to 12°.ConclusionsCleft reconstruction improves hand appearance in patients with central deficiency. A new technique of quantifying the radiographic divergence of the border rays of the cleft demonstrates improved alignment at long-term follow-up.Type of study/level of evidenceTherapeutic IV.