Foreword

You are holding a very special issue of “Handchirurgie, Mikrochirurgie, Plastische Chirurgie” in your hands. It is the very first issue of the German journal of hand surgery devoted entirely to congenital anomalies of the hand. And, it is also the very first issue of our journal made up almost entirely of articles written in English. Even though this latter aspect might raise a few eyebrows here and there between the North Sea/Baltic Sea and the Alps, I very much hope and am secretly convinced that the selection of invited authors from all over the world and the quality of their individual contributions will more than compensate for any potential skepticism on the part of our German-speaking readers.

This special issue of “Handchirurgie, Mikrochirurgie, Plastische Chirurgie” is not intended to be a textbook on congenital anomalies of the hand. It does, however, contain a very rich and valuable plethora of insightful and indepth articles ranging from very basic but also very demanding subjects such as genetics and embryology of the hand and upper extremity to observations and ruminations on some very rare conditions only to be encountered in the fascinating world of congenital anomalies of the hand.

Indeed, this world is a very special one and it is more than just a privilege to be able to deal with these endearing children, their uniquely individualized hands and their loving parents. Those of us who are captivated and enthralled by these special children and their special hands and needs are regularly confronted and confounded by an onslaught of questions none of us can easily answer. When is a hand “normal” and when is it no longer “normal”? What quality of “normality” should we be striving for in our superspecialized field of reconstructive surgery? Proximity to functional “normality”? Or proximity to aesthetic “normality”?

Since it is not always possible to demand, expect, and obtain surgical results which are equally pleasing from a functional as well as from an aesthetic point of view, difficult and highly individualized choices must be made. These choices may depend less upon the particular congenital anomaly of the hand under question, but more upon local and cultural surroundings. These choices may even be peculiar to the particular congenital hand anomaly under consideration. For instance, it is extremely difficult to improve the aesthetics of a true cleft hand without simultaneously compromising its strangely wonderful function; conversely, it is hardly possible to improve the function of a severe congenital transverse defect of the hand with the help of free toe transplants without simultaneously questioning the aesthetic result.

With time, I have come to appreciate that there are no clear-cut right or wrong decisions on how to treat an individual congenital hand anomaly. Rather, there seems to be a spectrum of options - similar to the spectrum of a teratologic sequence - ranging from better to poorer choices for a particular child. Recognizing and understanding this spectrum and learning to navigate it is the challenge.

As the Guest Editor of this special issue devoted entirely to congenital anomalies of the hand, I can vouch for the wealth of information that you as a reader can glean from every page of this issue of our journal. During the past twelve months, I have had the opportunity, honor, and great fortune to have been able to closely collaborate with all of the authors of this special issue. All share a similarly intense desire and passion to improve our understanding of congenital hand anomalies. Ultimately, we all have our minds and hearts set on improving the quality of care for children born with special hands.

I thank each author for sharing with us his wealth of personal knowledge and experience, observations, and technical “pearls”. I thank the Editors-in-Chief of our journal “Handchirurgie, Mikrochirurgie, Plastische Chirurgie” for their trust. And finally, I thank those special people from the Thieme Verlag for their quiet and helpful guidance.

Welcome to the jewelry of hand surgery!

Niels Benatar