Surgical management of adult hand macrodactyly in a 49-year-old patient: A case report

Figure 1 Histopathology finding. Micrograph of a median nerve biopsy (Toluidine Blue stain) showing an enlarged peripheral nerve, fatty infiltration within the peripheral nerve, and an abundance of fat around the median epineurium (magnification × 40).

Figure 2 X-ray views of the patient's hand and forearm. A and B: Representative preoperative radiographs showing substantial osteophyte formation around the thumb and index finger joints, with the space between the proximal parts of the first and second metacarpals, as well as the scaphoid, trapezium, and trapezoid bones, having disappeared; C and D: Representative anteroposterior and lateral radiographs of the elbow, revealing hyperostosis at the proximal radius where muscle attachments are present (arrows).

Figure 3 Computed tomography and 3D reconstruction imaging of the affected limb. A: Overgrowth of the bones; B: Thickening and tortuosity of the median nerve (arrow) at the wrist level.

Figure 4 Longitudinal ultrasound image at the level of the proximal carpal tunnel. Hypoechogenicity and enlargement of the median nerve is shown.

Figure 5 Preoperative and intraoperative appearance of the patient. A and B: Anteroposterior (A) and lateral (B) views of the hands affected by macrodactyly; C: Thickened median nerve (indicated by a black arrow); D: Extensive fatty tissue infiltration among the nerve fiber bundles.

Figure 6 Postoperative external and internal views of the affected limb. A and B: Representative images showing the surgical wound in good condition, with no signs of infection at the operation site; C and D: Representative X-ray images showing post-amputation of the thumb and osteophyte removal surgery of the index finger.

Figure 7 Six-year postoperative external and internal views of the hand. A and B: Post-debulking surgery images showing no significant overgrowth of soft tissue in the surgical area; C: X-ray image showing no significant increase in osteophytes around the first carpometacarpal joint, interphalangeal joint, and metacarpophalangeal joint of the index finger.