Congenital Pediatric Hand Surgery

Jenny Lee Nguyen, MD, FAAP I am honored to serve as the guest editor for this issue of Seminars in Plastic Surgery dedicated to pediatric congenital hand surgery. I decided to become a pediatric hand surgeon during my hand fellowship year when I rotated through Texas Children's Hospital under several of this issue's authors. Observing the pathology, the surgical treatment options, and the comprehensive evaluation and thought put into treatment of these patients, I realized that pediatric hand surgery is one of the purest forms of reconstructive surgery. The hand is central to a person's interaction with the environment. Our hands allow us to eat, brush our hair, put on our clothes, shake someone's hand, and caress a child's face. For children, it is one of the earliest ways they interact with their environment. As they grow, they reach out and touch everything they see, assimilating information to better understand their world. It allows them to explore, communicate, learn, play, comfort others, and ultimately develop independence. It would be easy to assume that a child born with a congenital hand difference should always undergo surgery to reconstruct the hand back to normal appearance both visually and radiographically. However, this is not true. Children are remarkably intelligent, resilient, and adaptive. Some congenital hand differences are well tolerated and do not benefit from surgical intervention, responding well to occupational therapy. Others are best served with surgery, which will dramatically improve their hand function. The key to treating these children is asking whether surgery is simply doing something to them or for them. Even though something is technically possible, it is not necessarily in the best interest of the patient. Our responsibility is not simply to perform an operation, but to understand the whole child. Successful treatment requires balancing functional goals with the child's developmental stage, associated medical conditions, family dynamics, cultural norms, emotional well-being, and anticipated needs as growth continues over many years. There is often not a single “correct” solution; rather, the best treatment is one that is thoughtfully individualized for each patient and family. As surgeons, we often measure success in technical terms—grip strength, depth of a web space, DASH scores. Families, however, measure success differently. They remember the first time their child buttoned a shirt independently, tied a shoe, or simply gained the confidence to participate fully in the world around them. Those moments remind us why it is a privilege to be a pediatric hand surgeon. We are not merely reconstructing hands; we are helping children realize their potential. Few fields in surgery offer the opportunity to have such a lasting impact on both function and quality of life. The articles in this issue reflect the breadth of contemporary congenital hand surgery, from upper extremity embryology to thumb deformities to the essential role of pediatric hand therapy. While each article focuses on a specific diagnosis or treatment strategy, together they reinforce a common principle: successful care begins with understanding the child in front of us and tailoring treatment to that individual's needs. I am deeply grateful to each of the authors who contributed to this issue. They are not only gifted surgeons but also trusted colleagues and friends whose collaboration has enriched both my professional career and this publication. Their generosity in sharing their experience has produced an outstanding collection of reviews that I hope will serve as a valuable resource for all involved in the care of children with congenital hand differences. Finally, I would like to thank the editorial leadership of Seminars in Plastic Surgery for the opportunity to serve as guest editor. It is an honor and a privilege. I hope this issue not only provides practical guidance for treatment but also inspires continued innovation, collaboration, and thoughtful care for the children and families we serve. Publication History Article published online: 21 July 2026 © 2026. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA