Complex management of macrodactylia of the hand: Between aesthetic and functional prejudice

Abstract

Macrodactylia is a rare congenital malformation of unknown origin that can affect the fingers or the toes. It is characterized by an increase in the size of all the elements of one or more rays, recognizable at birth or occurring in a progressive manner. Social, aesthetic as well as functional impact imposes early surgical management or even amputations in advanced forms. We report the case of a 18-year old unmarried, left handed patient without a profession, admitted to the Department of Burns, Plastic and Aesthetic Surgery at the University Hospital Mohammed VI in Marrakech, with progressive acrodactylia involving the first and the second ray of the right hand. Clinical examination showed hypertrophy of the first two rays of the right hand associated with predominant fibro-fatty infiltration of the palmar as well as phalanx deviation 90 degrees at the level of the second finger. Given the severity of the macrodactylia, amputation of the second ray associated with reduction of the fatty infiltration of the palmar was proposed to the patient, allowing him to maintain pollici-digital pinch and to return to a social life as close as possible to normal life.