Sandzén S C
Hand Clin. 1985 Aug;1(3):483-98.
Classification of central defect of the hand includes three general categories--Type I (typical), Type II (atypical), and Type III (two, three, and four digit hand). These three types of central defect have one common denominator--central metacarpal deficiency or absence. Otherwise, these three distinct types differ completely in inheritance pattern, characteristic features, bilaterality, and functional management. Functional management of the Type I central defect combines release of the tethered thumb metacarpal from its adduction contracture and simultaneous closure of the cleft using that redundant skin to fabricate a physiologic thumb-index web. Type II reconstructive procedures should be planned to provide as effective a pinch and grasp as possible between the radial and ulnar columns by deepening the central cleft, excising "digital nubbins" and any impinging skeleton, and performing rotational osteotomies of either metacarpal base or both and, occasionally, transfers to provide active digital flexion. Type III reconstructive procedures should release the adducted thumb and fabricate a physiologic thumb-index web along with appropriate releases of syndactyly. In the two-digit hand, rotational osteotomies may increase function.
手部中央缺损的分类包括三大类——I型（典型）、II型（非典型）和III型（二指、三指和四指手）。这三种类型的中央缺损有一个共同特点——中央掌骨缺损或缺失。否则，这三种不同类型在遗传模式、特征、双侧性和功能处理方面完全不同。I型中央缺损的功能处理包括将内收挛缩的拇指掌骨松解，并利用多余的皮肤同时闭合裂隙，以形成生理性的拇指-示指蹼。II型重建手术的规划应通过加深中央裂隙、切除“指结节”和任何撞击骨骼，并对掌骨基部进行旋转截骨术，或对两者进行截骨术，偶尔还需进行转移以实现主动手指屈曲，从而在桡侧和尺侧柱之间提供尽可能有效的捏握功能。III型重建手术应松解内收的拇指，并制作生理性的拇指-示指蹼，同时进行适当的并指松解。在二指手中，旋转截骨术可能会增强功能。
