Limb defects occur in up to 70 percent of babies with VACTERL association and include absent or displaced thumbs, extra digits [polydactyly], fusion of digits [syndactyly] and forearm defects, the commonest forearm deformity being absence of the radius [radial hemimelia].
Surgery is possible to help improve both the function and the appearance of the upper limbs. This can involve, reconstruction of a thumb from the index finger (a procedure known as pollicization), strengthening of an underdeveloped thumb [opponensplasty], removal of extra digits, separation of syndactyly, straightening of the wrist and lengthening of the forearm.
These operations are complex and require a thorough assessment of the child at a specialised hand unit so that an individualised treatment plan can be offered. Support from occupational therapists can be very helpful. The therapist will discuss any aids that may be useful to improve function for general activities of daily living as well as special equipment for use at work.
It is important to remember that children even with the most complex abnormalities of the upper limbs adapt remarkably well and can nearly always be totally self sufficient with regards to activities at school and at home.