Plastic surgery for the cleft hand.

A new procedure is described for cleft hands with absence of the middle finger associated with a palmar cleft. Three skin flaps are made within the cleft. The index ray is transferred ulnarward--not merely shifted ulnarly, but supinated--to prevent overlapping of the fingers when they flex. Length of the finger ray can be adjusted by shortening or lengthening the second metacarpal. The common extensor tendons to the index and ring fingers are interconnected with a free tendon graft to prevent the fingers from excessive spreading. The appearance is improved without disturbing the function of the hand.