Congenital Hand Anomalies — Embryology, Classification, Pollicization, and Reconstruction

This episode reviews the core principles of congenital hand anomalies, focusing on limb embryology, classification systems, functional diagnosis, and reconstructive strategy.Topics include upper limb development during weeks 4–8, the major embryologic signaling centers including the AER/FGF, ZPA/Sonic Hedgehog, and Wnt7a pathways, and modern classification using the Oberg-Manske-Tonkin (OMT) system. The episode also reviews longitudinal deficiencies, including radial longitudinal deficiency, ulnar deficiency, VACTERL, Fanconi anemia, TAR syndrome, and the importance of systemic workup before reconstruction.Thumb reconstruction is discussed through the Blauth classification, with emphasis on the distinction between a stable and unstable CMC joint, the scissor test, and indications for reconstruction versus pollicization. Surgical principles include web space deepening, UCL reconstruction, opponensplasty, and the Buck-Gramcko pollicization technique.Additional topics include cleft hand, symbrachydactyly, Poland syndrome, Wassel classification for thumb duplication, postaxial polydactyly, syndactyly release, Apert syndrome, amniotic band sequence, macrodactyly, Madelung deformity, and pediatric trigger thumb. Throughout the episode, the emphasis is on the central principle of congenital hand surgery: function over appearance.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordscongenital hand anomalies, limb embryology, AER FGF, ZPA Sonic Hedgehog, Wnt7a, Oberg Manske Tonkin classification, OMT classification, radial longitudinal deficiency, radial club hand, VACTERL, Fanconi anemia, TAR syndrome, Bayne Klug classification, ulnar longitudinal deficiency, cleft hand, Manske classification, symbrachydactyly, Poland syndrome, thumb hypoplasia, Blauth classification, pollicization, Buck-Gramcko technique, Wassel classification, thumb duplication, postaxial polydactyly, syndactyly release, Apert syndrome, amniotic band sequence, macrodactyly, Madelung deformity, pediatric trigger thumb