Macrodactyly is a congenital limb anomaly of overgrowth. It is one of the rare anomalies. It can affect the fingers or toes or the whole limb. It can be syndromic or non-syndromic. It is usually unilateral. It can be true macrodactyly when all the tissues except the blood vessels are enlarged or pseduomacrodactyly when the enlargement is due to the presence of neurofibromas or vascular lesions. The growth can be static (limb grows in proportion to the child) or progressive (disproportionate enlargement).
The affected digits are usually stiff with no movement at the joints. Hence it might affect the normal hand function. When the toe and feet are affected, it might affect shoe fitting.

Cause

  It is sporadic and not usually familial.

Treatment

  The surgical options include debulking or thinning the enlarged tissue, shortening the digits or ray amputation of the enlarged digit. The large digit with angular deformities may need multiple staged procedures that include soft tissue as well as bony surgeries.

After multiple surgeries including soft tissue debulking and bony procedures

  On the other hand, the enlarged digit can grow disproportionately big and interfere with hand function as these are usually stiff with little movement at the joints. Then amputation may be the choice of treatment.

After ray amputation of the large index finger and reconstruction of the tendons of the thumb

  The associated symptoms like tingling or numbness of the fingers might require decompression of the nerve by additional surgeries like carpal tunnel release. About 10% of the cases are associated with fusion or syndactyly of the enlarged digits.

After multiple surgeries including digital shortening, free nailbed grafting, debulking and bony procedures

Post-Operative Care

  Post-operatively, the hand will be immobilised in an above elbow Plaster of Paris slab or soft bulky dressing. The child can go home on day 3 or 4 of surgery. The dressing will be changed under anesthesia, at 10-14 days from the date of surgery. The dressing will be changed to a soft bulky one.

The child after correction of the left wrist deformity and pollicization for both the hands