Surgical Technique and Outcomes of Reconstruction for Blauth Type III Thumb Hypoplasia

Background Historically, amputation and pollicization has been the recommended surgical treatment for Blauth type III hypoplastic thumbs. However, due to aesthetic objections or cultural preferences, some parents seek out alternative surgical options. The present study describes a nontraditional technique that preserves and augments the hypoplastic thumb. Methods Patient charts were retrospectively reviewed to identify patients with Blauth type III hypoplastic thumbs who underwent thumb reconstruction at our institution from 2008 to 2018. The reconstruction procedure involved toe phalanx transfer, staged tendon transfers, and lengthening as needed. Motion was assessed categorically as ability to flex, extend, or oppose the thumb. Functionality was assessed as ability to pinch and grasp with the surgical hand. Patient- or parent-reported improvement in thumb function was also recorded. Results Of the 13 patients, 100% could flex, extend, and oppose the thumb to some degree. Eleven patients (85%) had functional one-handed grasp, and 9 (69%) had a functional pinch. Eleven patients (85%) reported no functional limitations of the operative hand. Thirteen patients (100%) reported improvement in hand function after surgery as compared to pre-operatively. There were 2 minor complications (15%), both of which resolved after intervention. No patients experienced donor-site morbidity. Conclusions Reconstruction of Blauth III thumbs is a nontraditional technique that allows for digit retention by salvaging the hypoplastic thumb. In the present study, the majority of patients had functional thumbs and all reported postoperative improvement. Overall, our results suggest that reconstruction is a viable surgical option for Blauth III hypoplastic thumbs.

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Restoration of Five Digit Hand in Type III B & C Thumb Hypoplasia–A Game Changer in Surgical Management

Indian Journal of Plastic Surgery ◽

10.1055/s-0040-1718858 ◽

2020 ◽

Vol 53 (03) ◽

pp. 349-356

Author(s):

G. Balakrishnan ◽

S. Vijayaragavan ◽

B. Somesh

Keyword(s):

Surgical Technique ◽

Donor Site ◽

Donor Site Morbidity ◽

Surgical Reconstruction ◽

Functional Improvement ◽

Carpometacarpal Joint ◽

Thumb Carpometacarpal Joint ◽

Type Iii ◽

Thumb Hypoplasia ◽

Hypoplastic Thumb

Abstract Background Hypoplasia of thumb is the second common congenital difference of the thumb, next only to duplication. It may occur as an isolated hand difference or as a part of radial longitudinal deficiency. In approximately 60% of these children, the radius shows hypoplasia. The incidence of thumb hypoplasia is one in 100,000 live births. In 50% of these children, the other hand will also have similar deficiency, although variable in severity. Hypoplasia of thumb has been classified into five major categories, according to the increasing severity of hypoplasia. Type III hypoplasia of thumb is characterized by skeletal hypoplasia involving the first metacarpal and carpometacarpal joint, absent intrinsic muscles and rudimentary extrinsic muscles. It was further subclassified into types A, B & C. Type III B, described by Manske and McCarroll, involves extensive deficiency of extrinsic and intrinsic musculature with aplasia of the metacarpal base. Type III C, described by Buck-Gramcko, has hypoplastic metacarpal head. Methods It is widely believed that reconstruction of Type III B & C hypoplastic thumb will not be functionally useful, and they are often included in the indications for pollicization in thumb hypoplasia. In India, we frequently come across parents, who are not willing to remove the hypoplastic digit. This forced us to find out a way to reconstruct the hypoplastic thumb into a functionally useful digit. We describe our surgical technique of reconstruction of hypoplastic thumbs and our experience in utilization of the technique in five children with Type III B & C hypoplasia of thumb. Carpometacarpal joint of thumb was reconstructed and stabilized with a toe phalangeal transfer in the first stage and an opponensplasty was done in the second stage to improve movement. Results In all the five operated children, our surgical technique yielded a stable thumb which was functional. The donor site morbidity was acceptable. The parents were satisfied with the appearance and functional improvement. Conclusion Surgical reconstruction of hypoplastic thumbs of Type III B & C is possible, and conversion of these poorly developed remnants into a useful digit by our surgical technique is a gamechanger in the management of thumb hypoplasia.

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Reconstruction of hypoplastic thumb using hemi-longitudinal metatarsal transfer

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411432677 ◽

2011 ◽

Vol 37 (8) ◽

pp. 738-744 ◽

Cited By ~ 13

Author(s):

C. S. Chow ◽

P. C. Ho ◽

W. L. Tse ◽

L. K. Hung

Keyword(s):

Hand Function ◽

Donor Site ◽

Normal Growth ◽

Wound Complication ◽

Reconstruction Method ◽

Type Iiib ◽

Contralateral Hand ◽

Permanent Morbidity ◽

Hypoplastic Thumb

The treatment of hypoplastic thumb (modified Blauth’s type IIIb and IV) by pollicization is culturally unfavourable in the Chinese population and digit preservation is preferred. An innovative reconstruction method using a nonvascularized hemi-longitudinal metatarsal graft was performed in six cases with an average follow-up of 87.7 months. Overall hand function was good, as assessed using the Jebsen hand function test. Grip strength and pinch power were significantly weaker than the normal contralateral hand. There was no neurovascular or wound complication. The only donor site complication was a metatarsal fracture, which healed uneventfully with casting. There had been no permanent morbidity to the donor site, as all donor metatarsals hypertrophied and regained normal growth potentials. Linear growth of the transferred metatarsals was evident radiologically (average 1.5 mm/year). Free hemi-longitudinal metatarsal transfer is a feasible method with good functional outcome in the attainment of a 5-digit hand in patients with type IIIb/IV hypoplastic thumb.

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Type IIIB and IV hypoplastic thumb reconstruction with non-vascularized fourth metatarsal

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420937547 ◽

2020 ◽

Vol 45 (7) ◽

pp. 722-728 ◽

Cited By ~ 1

Author(s):

Bo Liu ◽

Shanlin Chen ◽

Esther Ching San Chow ◽

Pengcheng Li ◽

Kun Liu ◽

...

Keyword(s):

Hand Function ◽

Donor Site ◽

Donor Site Morbidity ◽

Pinch Strength ◽

Reconstruction Method ◽

Level Of Evidence ◽

Type Iv ◽

Type Iiib ◽

Rotational Flap ◽

Staged Reconstruction

We treated 16 patients with 17 hypoplastic thumbs (eight Type IIIB and nine Type IV) using a non-vascularized fourth metatarsal transfer with a rotational flap and multi-staged reconstruction. The average age at the first operation was 24 months. The average follow-up time was 46 months. All patients achieved reasonable hand function and were able to use the reconstructed thumb to grip small and large objects. The operated thumb achieved an average Kapandji score of 6.7 and average pinch strength of 0.9 kg. There were two cases of graft nonunion. All parents are satisfied with the function and appearance of the reconstructed thumb and donor foot. We conclude that non-vascularized fourth metatarsal transfer is a feasible reconstruction method for patients with Types IIIB and IV hypoplastic thumbs. The reconstruction allows for the preservation of a 5-digit hand with reasonable function and appearance and minimal donor site morbidity, although long-term growth of the metatarsals still need to be monitored. Level of evidence: IV

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Fifth toe Fillet Flap for Wound Coverage of Non-Healing Ulcer of the Foot: Surgical Technique and a Case Report

Asian Journal of Medical Research ◽

10.47009/ajmr.2020.9.2.or2 ◽

2020 ◽

Vol 9 (2) ◽

pp. 7-10

Author(s):

Sunny Chaudhary ◽

Shivakumar A Bali ◽

Arvind Singh ◽

R K Siddharth

Keyword(s):

Case Report ◽

Surgical Technique ◽

Functional Limitations ◽

Donor Site ◽

Donor Site Morbidity ◽

Healing Ulcer ◽

Wound Coverage ◽

Fillet Flap ◽

Plantar Aspect ◽

Partial Amputation

Fillet flap is one of the options in the treatment of diabetic non-healing ulcers. The advantages of the fillet flap include the absence of donor site morbidity, excellent durability and preventing the need for more proximal amputation. A 56-year-old farmer presented to the out-patient department with complaints of a non-healing ulcer on the sole of the right foot for the past 7 months which was managed conservatively. A fifth ray partial amputation and a rotational flap of the redundant fifth finger for wound coverage were done. The wound healing was uneventful and the sutures were removed after two weeks. At the latest follow-up of 2 years, the patient was able to walk independently without pain and without any functional limitations. This case report describes the surgical technique of the lateral lesser toe fillet flap for wound closure on the plantar aspect of foot as an alternative to secondary healing or more proximal amputations.

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The First Stage of Acquired Syndactyly Reconstruction - A Rare Case Report

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20220112 ◽

2022 ◽

Vol 12 (1) ◽

pp. 87-91

Author(s):

Lucretya Yeniwati Tanuwijaya ◽

Agus Roy Rusly Hariantana Hamid ◽

I Gusti Putu Hendra Sanjaya

Keyword(s):

Case Report ◽

Skin Graft ◽

Skin Flap ◽

Donor Site ◽

Surgical Techniques ◽

Operation Time ◽

Donor Site Morbidity ◽

Reconstruction Procedure ◽

Local Skin ◽

And Function

Background: Acquired syndactyly is a very rare disorder on the interdigital area. Syndactyly with only soft tissue involvement can be a sequela of trauma, such as burn, inflammation or infection in the interdigital area, resulting in bony fusion following crush injury. Case Report: An 8-year-old boy came to our department with fusion from the base to the tip of the first to fourth right toes since the accidental step on burnt plastic 5 years ago. He complained of a poor appearance and discomfort when walking. Then we performed zigzag incision for first to second toes and third to fourth toes. Skin graft closure was performed to cover the defect on third to fourth toes. The second reconstruction surgery will be scheduled 6 months later. Discussion: The surgical techniques for foot syndactyly were derived from those for hand syndactyly, which are to separate the digital fusion by creating local skin flap. Additionally, skin graft might be necessary when recent surgeons avoid the use of skin graft for open treatment, primary closure by defatting, or intricate local flaps. These can shorten the operation time and minimize donor site morbidity. However, surgeons should consider the free tension closure of the wound by combining the skin graft after the flap. Conclusion: Reconstruction procedure for foot syndactyly aims to improve the appearance and function of the toes as well as to avoid progressive deformity through development. The skin graft addition in combination of skin flap shows promising outcome. Key words: acquired syndactyly, syndactyly reconstruction, zigzag flap, skin graft.

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Single incision thenar muscle reconstruction using the free functional pronator quadratus flap

BMC Surgery ◽

10.1186/s12893-021-01308-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Martin Aman ◽

Arne H. Boecker ◽

Mirjam Thielen ◽

Camillo T. Mueller ◽

Amir K. Bigdeli ◽

...

Keyword(s):

Grip Strength ◽

Single Incision ◽

Hand Function ◽

Donor Site ◽

Donor Site Morbidity ◽

Viable Alternative ◽

Thenar Muscle ◽

Pronator Quadratus ◽

Tendon Transfers ◽

Single Incision Surgery

Abstract Background Injuries to the thenar muscle mass or the thenar branch of the median nerve and resulting loss of thumb opposition lead to a massive impairment of hand function. For decades, reconstructive approaches were based on tendon transfers. To broaden the reconstructive repertoire, we present the free functional pronator quadratus flap as a viable alternative for functional reconstruction and provide a specification for its indication. We demonstrate our surgical technique to a single incision reconstruction using the free functional pronator quadratus flap. Based on a series of three patients, which were analyzed for hand function using Kapandji’s score and the angle of Bourrel, grip strength and nerve conduction velocity in a two year follow up, we present an indication algorithm. Results After successful reinnervation of all flaps, we found an improvement of Kapandji’s score from 4.3 ± 0.94 preoperatively, to 8.7 ± 0.47 after two years. Accordingly, the angle of Bourrel decreased from 75.75 ± 3.45 degrees to 36.96 ± 3.68 degree. Grip strength also improved from 14 ± 2.2 kg to 26.2 ± 1.2 kg. No impairment of wrist pronation was observed. Conclusion We found excellent functional recovery of thumb opposition and strength, showing similar or even superior results compared to results from tendon transfers. With the benefit of a single incision surgery and therefore minimal donor site morbidity, this free functional muscle transfer is a viable alternative to classic tendon transfers.

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A STUDY ON DIFFERENT SURGICAL OPTIONS OF LOWER THIRD LEG DEFECTS AND ITS OUTCOME

10.36106/5229814 ◽

2021 ◽

pp. 32-34

Author(s):

Ajay Kumar Pathak ◽

Md Ghulam Jeelani Naiyer ◽

Pragati Awasthi

Keyword(s):

Reconstructive Surgery ◽

Soft Tissues ◽

Donor Site ◽

Donor Site Morbidity ◽

Tissue Loss ◽

Conventional Teaching ◽

Surgical Options ◽

Soft Tissue Loss ◽

Flap Cover ◽

Upper Third

Background: The bones of the lower third are vulnerable to injury. Due to the paucity of soft tissues around them, the fractures that occur are often open. Most muscles become tendons at that level and in the case of soft tissue loss, skin graft may not sufce and flap cover becomes mandatory. Conventional teaching recommends gastrocnemius muscle and myocutaneous aps and fasciocutaneous aps for the upper third leg defects, soleus aps for the middle third defects and free aps for the lower third defects. Aim: Different surgical options in management of lower third leg defects. Material And Method: The study was conducted from JANUARY 2018 to December 2019, in the Department of Plastic & Reconstructive Surgery Institute of Post Graduate Medical Education and Research (IPGME&R) and SSKM Hospital, KOLKATA. Result: 70 patients admitted to the Department of Plastic & Reconstructive Surgery and referred patients from Department of General Surgery & Orthopaedic Surgery, IPGME&R and SSKM Hospital, KOLKATA. Association of FLAP LOSS with Pedicled ap was statistically signicant (p=0.0259). We found that association of DONOR SITE MORBIDITYwith Pedicled ap was not statistically signicant (p=0.7679). Conclusion: We consider that perforator propeller aps are ideal in reconstructing small-medium defects of the middle and distal third of the leg, being safe, easy to perform, providing similar tissue in texture and thickness of damaged tissues, with low donor-site morbidity.

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The Use of Thick Split Thickness Grafts from the Instep in Paediatric Hand Surgery

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_85_90012-9 ◽

1985 ◽

Vol 10 (2) ◽

pp. 185-189

Author(s):

CHRISTOPHER WARD ◽

JENNIFER ECCLESTONE

Keyword(s):

Clinical Study ◽

Hand Function ◽

Donor Site ◽

Skin Grafting ◽

Hand Surgery ◽

Donor Site Morbidity ◽

No Donor ◽

Recipient Site ◽

Aesthetic Result ◽

Good Aesthetic Result

In skin grafting the hand restoration of function must always be the priority, but an acceptable appearance is also important and care should be taken in selecting a skin graft that matches the recipient site. The disadvantages of some traditional donor sites are outlined. A clinical study of thick, split-thickness grafts from the instep is described from which it is concluded that a good aesthetic result can be achieved without compromising hand function—but only in children and adolescents among whom there was no donor site morbidity.

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THE "LOCAL DORSAL ADIPOFASCIAL FLAP" FOR VOLAR DIGITAL DEFECTS: A CASE REPORT

Hand Surgery ◽

10.1142/s0218810411005746 ◽

2011 ◽

Vol 16 (03) ◽

pp. 379-381

Author(s):

Emmanuel P. Estrella ◽

Ruth A. Padua

Keyword(s):

Simple Procedure ◽

Donor Site ◽

Early Mobilization ◽

Donor Site Morbidity ◽

Single Patient ◽

Second Stage ◽

Adipofascial Flap ◽

Good Healing ◽

Surgical Options ◽

The Ideal

The coverage of volar digital defects can be achieved by a variety of surgical options. Although frequently used and reliable, these procedures entail the need for a second stage for flap release, meticulous dissection, sacrifice of a digital artery of the uninvolved digit, or delayed mobilization resulting in digital stiffness. The ideal surgical procedure for such defects should be a simple, single-stage surgery that allows early mobilization and return to function and at the same time avoiding unnecessary donor site morbidity from an uninvolved digit. The "local dorsal adipofascial flap" is a simple procedure that does not need a secondary procedure for flap release and affords early range of motion and return to function. We used this new flap technique in two digits with volar defects in a single patient. At ten months after flap coverage, the fingers were fully functional with good healing of the "local dorsal adipofascial flap."

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Donor site morbidity following microvascular fibula transfer

International Surgery Journal ◽

10.18203/2349-2902.isj20204123 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3285

Author(s):

Joyce Jesudass ◽

Anoop Sivakumar ◽

Rakesh Kain

Keyword(s):

Functional Limitations ◽

Donor Site ◽

Donor Site Morbidity ◽

Flexor Hallucis Longus ◽

Free Fibula Flap ◽

First Choice ◽

Vascularized Fibula ◽

Free Fibula ◽

Pedicle Length

Background: The free vascularized fibula has become the first choice of vascularised bone transfer. The advantages of fibula over other microvascular flaps include greater bone length, sufficient pedicle length and size, rich periosteal blood supply, etc.Aim: This study was designed to evaluate the long-term donor site morbidity following microvascular fibula transfer.Methods: This study was conducted over two years, in patients who underwent free fibula flap for various defects which needed a composite osseo-fasciocutaneous flap. They were followed up for one year and the donor site evaluated for complications like edema, pain, anaesthesia, spasm of muscles, Flexor hallucis longus (FHL) contracture, ankle stability and hypertrophic scarring.Results: 28 patients, age ranging 15 to 56 years, of which 22 were male and 6 were female. Total of 7 patients (25%) had complications, of which 6 patients had more than one complication. No patients experienced knee instability, weakness, or decreased range of motion. All patients returned to their normal ambulatory status.Conclusion: Free fibula transfer does have long term donor site complications, but they can be managed conservatively, seldom requiring surgical intervention. However, there are no functional limitations which makes it a feasible option in reconstructing a composite defect.in various literatures.

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