Sometimes, in families with cleft hand with good function, operations for cosmetic aspects are considered marginal  and the families choose not to have surgery. Indications
Surgical treatment of the cleft hand is based on several indications:
Improving function
Absent thumb
Deforming syndactyly (mostly between digits of unequal length like index and thumb)
Transverse bones (this will progress the deformity; growth of these bones will widen the cleft)
Narrowed first webspace
The feetAesthetical aspects

Reducing deformity

Timing of surgical interventions
The timing of surgical interventions is debatable. Parents have to decide about their child in a very vulnerable time of their parenthood. Indications for early treatment are progressive deformities, such as syndactyly between index and thumb or transverse bones between the digital rays. Other surgical interventions are less urgent and can wait for 1 or 2 years. Classification and treatment
When surgery is indicated, the choice of treatment is based on the classification. Table 4 shows the treatment of cleft hand divided into the classification of Manske and Halikis. Techniques described by Ueba, Miura and Komada and the procedure of Snow-Littler are guidelines; since clinical and anatomical presentation within the types differ, the actual treatment is based on the individual abnormality.Table 4: Treatment based on the classification of Manske and Halikis

Snow-Littler
The goal of this procedure is to create a wide first web space and to minimise the cleft in the hand. The index digit will be transferred to the ulnar side of the cleft. Simultaneously a correction of index malrotation and deviation is performed.
Description
Bitlis preserves more medieval and traditional architecture than any other town in eastern Turkey. They are of a high quality and are mostly constructed from locally quarried light-brown stone, sometimes called Ahlat stone. The town contains a large number of late-medieval Islamic buildings in the form of mosques, madrassas, and tombs. Also commercial buildings such as "Hans Caravanserais. Commissioned mostly by its local Kurdish rulers, the architectural style of these buildings is very conservative and similar to much earlier Seljuq-period structures. Important monuments include the 12th-century Ulu Mosque with its 15th-century minaret, and the Gokmeydani Medresesi and Sherefiye Mosque from the sixteenth century. Until 1915 there were five Armenian monasteries and several churches in Bitlis – only a 19th-century Armenian church survives, now used as a warehouse.Bitlis is also notable for its many old houses. These are built of cut stone and are often large and impressive structures. Most have two stories, but three stories are also found. Ground floors were generally intended for storage and stables, with the residential quarters on the upper floors. Ground floor rooms have few windows, upper floors are well lit. Roofs are flat and covered with beaten clay. Unlike traditional houses in nearby Erzurum or Van, Bitlis houses do not have bay windows and balconies. Gallery
Demographics
According to Encyclopædia Britannica Eleventh Edition from 1911, the town had 35 thousand people with 12 thousand Armenians, the rest being Kurdish. Climate
Bitlis has a dry-summer humid continental climate according to the (Köppen climate classification: Dsa, or Trewartha climate classification: Dca).