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the hand and calling more attention to the abnormality. If a hand with normal
appearance cannot be attained, realistic goals need to be discussed and
approaches to minimize attention-drawing features considered.
Figure 3. Reconstruction of a mirror hand (pre-axial polydactyly) with pollicization of
one of the pre-axial digits. A-C) Preoperative view of the mirror hand with 3 additional
pre-axial digits: Dorsal view (A), ventral view (B) and radiograph (C). D-E.
Intraoperative views of the repair. View from the lateral (radial) aspect following
rotation and reconstruction of the pollicized digit (D). Volar (anterior) view post-
reconstruction of the “new” thumb (E). Several months post-operative (F). From
Virchel Wood, “Reconstruction of mirror hands,” Congenital Hand Anomaly Study
Group (CHASG), 1995, Tampre, Finland and from Wood. (Wood, 1993).
The timing of conservative therapy or operative repair for most CULA is
typically initiated within the first 18 months of life in an effort to optimize the
anatomy for which the child will learn to use (Tonkin, 2004). There are several
notable exceptions. Trigger fingers may resolve without intervention and
observation or conservative management is typically preferred over more
aggressive early intervention. The natural progression of camptodactyly and