Congenital Hand Anomalies: Neural Adaptation After Surgical Reconstruction

ანოტაცია

Congenital hand anomalies, such as syndactyly, amniotic band syndrome (ABS), and congenital amelia, significantly modify hand structure, compromise functional abilities, and contribute to altered organization within the central nervous system. Reconstructive surgery seeks not only to restore anatomical form and fine motor capacity but also to facilitate the reintegration of reconstructed digits into existing cortical representations. Postoperative neural adaptation is primarily mediated through use-dependent plasticity, with magnetoencephalography studies demonstrating that somatosensory cortical maps can reorganize rapidly, even in mature brains. Timely surgical intervention leverages enhanced developmental plasticity, promoting more effective incorporation of reconstructed digits into functional sensorimotor pathways, whereas severe or complex anomalies may restrict the degree of achievable cortical reorganization. Advanced microsurgical techniques, including staged reconstructions and vascularized toe-to-hand transfers for ABS, offer sensate and functionally robust units that support both anatomical restoration and neuroplastic recovery. Structured postoperative rehabilitation further strengthens these adaptive cortical processes, underscoring the essential relationship between surgical technique, neural mechanisms, and functional outcomes. This review integrates current evidence on congenital hand anomalies, emphasizing cortical adaptation, postoperative function, and the translational relevance of surgical timing, operative strategy, and rehabilitation protocols.