ABSTRACT
Objective: To explore the clinical efficacy of digital arteria axial flap augment volume in the treatment of Wassel type III- V congenti tal thumb duplication, and to provide the basis for its clinical treatment. Methods: The thumb augment volume surgery was performed in 14 children with Wassel type III-V congenital thumb dupliation. A narrow and long flap with vascular vessel and soft tissue was designed with microsurgical technique to augment the soft tissue of the reconstructed thumb and reconstruct the perimeter and appearances of the reconstructed thumb. The perimeters and appearences of the reconstructed thumb and healthy thumb were detected before and after surgery. Results: All the flaps were survived after the surgery. The average perimeter of the reconstructed thumb was 89% -104% relative to the healthy contralateral thumb based on the data detected from the tuberositas unguicularis, proximal interphalangeal joint, proximal phalanx midshaft, metacarpophalangeal joint and metacarpal midshaft. The appearance of reconstructed thumb was more similar to that of healthy thumb. Conclusion: The digital arteria axial vascular flaps which are used to augment the volume of reconstructed thumb of Wassel type IH - V congenital thumb duplication can be easily obtained and the reconstructed thumbs have better appearences. The surgery is an effective way to improve the thin and small appearences of reconstructed thumbs.
ABSTRACT
Objective: To explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication. Methods: Twelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of 9-32 months (mean, 13.3 months). Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side (mean, 75.3%). The degree of fullness was 50%-75% of the healthy side (mean, 62.4%). The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of abdominal circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand (JSSH) scoring. Results: All the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months (mean, 14.3 months). At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry was improved in all cases. The ratio of abdominal circumference of deformed finger to contralateral finger was 93%-96% (mean, 94.7%). The JSSH score was 15-20 (mean, 17.9); the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases. Conclusion: The anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.
ABSTRACT
Within the Oberg, Manske, Tonkin (OMT) classification, thumb duplications are a failure of formation and/or differentiation affecting the radial-ulnar axis of the hand plate. The Wassel description of seven types of thumb duplication provides a good structure from which an approach to management is based. The aim of surgical reconstruction is to obtain a stable, mobile thumb of adequate size and appropriate shape. The most common form of reconstruction is removal of the lesser digit and reconstruction of the dominant digit. Surgical techniques address the problems of deviation, instability and lack of size. The disadvantages of the Bilhaut-Cloquet procedure, these being joint stiffness and a nail ridge, may be lesser concerns when reconstruction of one digit will not create a satisfactory thumb of adequate mobility, stability, alignment and size. Complicated problems of triphalangism, triplication, ulnar dimelia and the rare circumstance in which neither of the duplicated thumbs may be adequately reconstructed present specific challenges which demand alternative techniques.
Subject(s)
Humans , Hand Deformities, Congenital/classification , Orthopedic Procedures/methods , Patient Care Planning , Plastic Surgery Procedures , Thumb/abnormalitiesABSTRACT
Within the Oberg, Manske, Tonkin (OMT) classification, thumb duplications are a failure of formation and/or differentiation affecting the radial-ulnar axis of the hand plate. The Wassel description of seven types of thumb duplication provides a good structure from which an approach to management is based. The aim of surgical reconstruction is to obtain a stable, mobile thumb of adequate size and appropriate shape. The most common form of reconstruction is removal of the lesser digit and reconstruction of the dominant digit. Surgical techniques address the problems of deviation, instability and lack of size. The disadvantages of the Bilhaut-Cloquet procedure, these being joint stiffness and a nail ridge, may be lesser concerns when reconstruction of one digit will not create a satisfactory thumb of adequate mobility, stability, alignment and size. Complicated problems of triphalangism, triplication, ulnar dimelia and the rare circumstance in which neither of the duplicated thumbs may be adequately reconstructed present specific challenges which demand alternative techniques.