ASPS member yields positive results in treatment of 'mirror hand'

It's estimated that only about 100 children in the world suffer from a condition called ulnar dimelia, which is more commonly known as "mirror hand." Fortunately for a young boy born with the anomaly during the COVID-19 pandemic, ASPS member Scott Oishi, MD, Dallas, had previously treated the condition – and he was confident he could achieve a positive outcome for Brigham "Briggs" French.

After traveling nearly 130 miles from Longview, Texas, to Dallas, Briggs' parents presented their boy to Dr. Oishi at Scottish Rite Hospital in Dallas. Briggs, who was born with a left hand that had seven fingers and no thumb, came under Dr. Oishi's care at Scottish Rite soon after birth. Briggs' father, Robert, described his son's condition to ABC 7 KLTV in Texas by telling viewers to "think of your pinky and imagine having seven of those... Then imagine having your hand pinned down and back."

Since Briggs' condition affected his entire upper limb – extending from his shoulder to his hand – Dr. Oishi performed pollicization surgery when Briggs reached age 4. However, the boy underwent his first surgery at just 11 months of age in order to release his elbow to allow passive flexion as well as biceps transfer. This was followed by stretching and splinting of his wrist and eventual wrist contracture release, as well as bi-lobed flap along with tendon transfer, at age 3. After Dr. Oishi assessed Briggs' hand to determine which finger would make the best thumb, the boy underwent the pollicization procedure, wherein Dr. Oishi and his team created a thumb from one of Briggs' extra fingers and removed the three remaining fingers.

"This procedure is quite difficult because there are so many extra fingers," Dr. Oishi says.

Although pollicization procedures in and of themselves aren't necessarily challenging for plastic surgeons, the fact Briggs was so small added a layer of concern that wouldn't exist with older, larger patients.

"The pollicization procedure is stressful, as it not only involves transposing a finger on small vessels but also re-contouring the hand after removal of the 'extra fingers,' " Dr. Oishi notes. "The best moment arrived when we finished the procedure and were able to let the tourniquet down – and then watched as the finger regained its pink hue due to the blood flow. For me, that was the most angst-provoking part of the entire process. You just don't know how well it's gone until you've finished."

Dr. Oishi says he felt the responsibility of giving the child an outcome that will help him negotiate his place in the world as he grows. Although it's still early in Briggs' recovery, Dr. Oishi says he is satisfied with his progress.

"It's been very successful," Dr. Oishi says. "He's doing better than I would have thought because it's not a standard pollicization. This is a little different because there are many tendons and fingers involved, so it really took some doing to determine how to construct the most normal hand possible. It has been good to see his progress. He's about five or six months out now, but he's already starting to use it to grab things and do things he couldn't do before, because he didn't have that grasp in his palm or his hand.

"In Briggs' case, it wasn't only a functional problem; it also posed an aesthetic problem," he adds. "We've hopefully given him a solution in that as he gets older, he'll feel more accepted in the community and school – having a hand that looks more like somebody else's. And if we can give him a normally functional extremity, he'll be active and succeed in life. That's what we're trying to do."