ABSTRACT
Background@#The predominant method for Manske type IIIB and IV thumb hypoplasia is pollicization. However, for those who are not willing to sacrifice the index finger, a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable. This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative.@*Methods@#From May 2014 to January 2017, 15 patients with Manske type IIIB or IV thumb hypoplasia who were admitted to the Department of Hand Surgery, Beijing Jishuitan Hospital were included in this study. An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint. The donor site was reconstructed by a split half of the third metatarsal. Various functional reconstructions were commenced at second stage. The reconstructed thumbs were evaluated using the Kapandji score, pinch force, and the capacities of performing daily activities through a detailed questionnaire.@*Results@#Among these 15 patients (seven type IIIB and eight type IV), there were ten boys and five girls with median age of 4.2 years (range: 2.0-7.0 years). There were seven right, three left, and five bilateral thumbs for whom only the right thumb received surgery. There were 14 metatarsal flaps survived (14/15). With an average follow-up of 19.2 months, the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function. All 15 children have improved the Kapandji score (from 0 to an average of 6.7), pinch force (from 0 to an average of 1.5 kg), with ability of grip and pen holding. X-ray indicated continuous bone growth. Patients and parents had good acceptance of the new thumb.@*Conclusions@#Reconstruction of an unstable hypoplastic thumb (Manske type IIIB and IV) with use of a vascularized metatarsal is an effective strategy. It offers an alternative solution for parents insisting on saving the thumb.
ABSTRACT
La pulgarización del dedo índice permite reconstruir la pinza de la mano. Fue ampliamente realizada para una reconstrucción de una pérdida de pulgar en condiciones de trauma. Sin embargo, hoy por hoy, es la técnica de elección para las hipoplasias congénitas de pulgar. En los niños permite crear una pinza, especialmente para objetos grandes y entrega una apariencia más normal de la mano. Es una técnica demandante, pero con pasos que están bien definidos y perfeccionados, que al ser realizados de forma cuidadosa, reducen al mínimo sus complicaciones.
The pollicization of the index finger allows reconstructing the hand's ability to pinch. It has been broadly used to address traumatic loss of the thumb. However today it is the procedure of choice for severe congenital thumb hypoplasia. It allows children to pinch, particularly large objects, it also gives the hand a more normal appearance. It is a demanding procedure, with a series of technical steps that are well defined and perfected, such that if they are performed in a careful way, complications are minimized.
Subject(s)
Humans , Fingers/transplantation , Thumb/abnormalities , Thumb/surgery , Treatment OutcomeABSTRACT
Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.
Subject(s)
Humans , Fingers/abnormalities , Hand Deformities, Congenital/rehabilitation , Orthopedic Procedures/methods , Plastic Surgery Procedures/methods , Thumb/abnormalitiesABSTRACT
Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.
Subject(s)
Humans , Fingers/abnormalities , Hand Deformities, Congenital/rehabilitation , Orthopedic Procedures/methods , Plastic Surgery Procedures/methods , Thumb/abnormalitiesABSTRACT
PURPOSE: Thumb hypoplasia gives rise to various derangement of hand functions, leading to various degrees of malformation. The treatment of choice for grade IV or V congenital hypoplasia of the thumb, classified by Buck-Gramcko's criteria, is the pollicization of the index finger. The purpose of this article is to review the clinical usefulness of pollicization for more than grade IV hypoplasia. MATERIALS AND METHODS: Three grade IV and 3 grade V hypoplastic thumbs in 6 patients, one with radial club hand, were reviewed retrospectively. They underwent pollicization between 1987 and 1997. The index metacarpi were osteotomized for shortening and readjusted by pronation. To evaluate postoperative function, authors used the criteria of Sundararaj and Mani. RESULTS: Except for the exclusion of one patient, four had excellent and one had good functional statuses. CONCLUSION: Pollicization was considered to be worthwhile for functional improvement of the hands in more than grade IV congenital hypoplasia of the thumb.