A Three-Stage Surgical Approach to Preserving a Severely Hypoplastic Thumb with Syndactyly

An 11-month-old male child presented with severe congenital thumb hypoplasia, syndactyly of the thumb and index finger, and radial longitudinal deficiency. A novel three-stage surgical approach was performed to achieve functionality while respecting familial preference for thumb preservation using sequential syndactyly release, structural reconstruction using bone graft, and muscle and tendon transfers. The reconstructed thumb demonstrated early wound healing, stable alignment, and maintained a 45-degree palmar abduction even up to 5 years postoperatively. Despite minor fine motor limitations, the patient showed functional improvement and performed activities of daily living excellently, successfully meeting esthetic and functional goals.