Congenital Upper Limb Anomalies 187the typically poor results from operative intervention prompts observation and
consultations with patient and families regarding realistic expectations for any
intervention. Reconstruction of a symbrachydactyly is complicated and may
encompass a series of operations that include a toe transfer. Optimal adaption
to the reconstructed anatomy is always considered; however, musculoskeletal
and vascular development of the symbrachydactyly and toe for transfer are
also important to ensure success. Thus, a delay until 2-3 years of age is
considered more optimal. Although early intervention has benefits, there may
be a number of reasons to defer intervention including parental apprehension.
Honest open discussions with the parents about options and outcomes is the
responsibility of the caregiver, and it may take some time to collectively
develop a plan of treatment for the child that the parents can support with
confidence.
ACKNOWLEDGMENTS
This work was supported in part by a grant from the Pathology
Endowment fund (KCO) and funds from Loma Linda University School of
Medicine (BAW). The authors thank Charmaine Pira for review and insightful
suggestions.
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