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The surgery carried out by Dr. Cowen, to Josefa's hands, is called "Distraction Augmentation Manoplasty". This surgery creates growth at the rate of an inch of bone a month, to create new palms and to lengthen the fingers. It consists of the insertion of a device through the bone which is a complex group of bars, nails and steel screws. It requires screwing several turns per day to reach a growth rate of up to 1 ml. daily.

Lengthening device

After many months and several operations, Dr. Cowen achieves the desired objective. Children are able to have new and functional hands with which they can manipulate objects. And something very important, they can feel, with the normal or almost normal sensibility of any healthy finger(s).

This technique was used for the first time in mature people in 1970 by Dr. Matev of Bulgaria, and in children in 1977 by Dr. Isador Kessler of Israel. But from 1978 onward Dr. Cowen has become the number one world leader in the reconstruction of children's hands by means of the lengthening procedure. In the same way as what happened with Josefa, many patients of Dr. Cowen often have been seen by other doctors that don't give them hope, or tell them that they have done all they can with their hands without themselves knowing at least that this technique perfected by Dr. Cowen exists.
The procedure consists of cutting the small existing bone and stretchign it slowly with the distraction apparatus. What will become a finger in several months, lengthens slowly until an inch per month. A bone implant is extracted from the fibula and grafted to the space among the two bone segments to create a new finger. All that is connected to the bone stretches out with it. The finger has in this way all the nerves, arteries and necessary tendons to do their usual work.

Offices - Dr. Norman J. Cowen

In children with very severe birth defects, as was the case with Josefa, Dr. Cowen lengthen simultaneously the fingers and the palms of the hands to reach a superior cosmetic effect. The children can be born without palm, without fingers and/or with very little wrist, or any number of abnormal fingers. The objective of Dr. Cowen varies from creating new fingers which might help a child to catch a toothbrush or to grab small objects, until lengthening the fingers to obtain a practically normal hand. The desired result is a sensitive hand that the children can use without having to look at what they are doing. This procedure has been done in children of all ages; from several months, but the best age is around 2 to 2 and a half years for the girls and 3 years for the boys. At this age, the hand is half of the mature size and the future size of the hand one can predict. If bone implants are needed these are extracted approximately the 15-18 months of age. Preliminary implants of the phalanges of the toes can provide knuckles manoplasties where before there was only metacarpals.

Getting ready for another of so many surgeries

The selection of the patient is critical for the success of the reconstruction. The parents should be mature, they should lean on each other mutually and most important they should have the ability to control their children. If the parents are afraid, they discuss, or they don't discipline their children, the children will reflect these problems. Complications can happen with any patient, but they will decrease with meticulous cleaning, constant observation and the attention of responsible parents. Most of the parents who have finished this process are satisfied with the results and would repeat it another time, if it were necessary.


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