Soft tissue balance technique by flexor pollicis longus tendon transfer for Wassel <b>Ⅳ</b>-D thumb duplication in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

REN Hongjun ¹ ,  YANG Yong ² , ZHONG Wenyao ² , ZHAO Zhanwei ¹

1. Department of Hand Surgery, Beijing Shuili Hospital, Beijing, 100036, P. R. China;
2. Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;

Corresponding author：

YANG Yong, Email: 0414yang@sina.com

Keywords：

Wassel Ⅳ-D thumb duplication; soft tissue balance technique; flexor pollicis longus; child

DOI：

10.7507/1002-1892.202110058

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side. Conclusion The soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.

Citation： REN Hongjun, YANG Yong, ZHONG Wenyao, ZHAO Zhanwei. Soft tissue balance technique by flexor pollicis longus tendon transfer for Wassel Ⅳ-D thumb duplication in children. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 395-399. doi: 10.7507/1002-1892.202110058 Copy

1.	高伟阳, 丁健, 周宗伟. 先天性多拇畸形的研究进展. 中国修复重建外科杂志, 2018, 32(7): 827-831.
2.	Perez-Lopez LM, la Iglesia DG, Cabrera-Gonzalez M. Radial polydactyly. What’s new? Curr Pediatr Rev, 2018, 14(2): 91-96.
3.	Cheng JC, Chan KM, Ma GF, et al. Polydactyly of the thumb: a surgical plan based on ninety-five cases. J Hand Surg (Am), 1984, 9(2): 155-164.
4.	Wassel HD. The results of surgery for polydactyly of the thumb. A review. Clin Orthop Relat Res, 1969, (64): 175-193.
5.	Manske MC, Kennedy CD, Huang JI. Classifications in brief: The Wassel classification for radial polydactyly. Clin Orthop Relat Res, 2017, 475(6): 1740-1746.
6.	Lin S, Tong K, Zhang G, et al. Clinical characteristics and distribution of thumb polydactyly in South China: A retrospective analysis of 483 hands. J Hand Surg (Am), 2020, 45(10): 938-946.
7.	Hung L, Cheng JC, Bundoc R, et al. Thumb duplication at the metacarpophalangeal joint. Management and a new classification. Clin Orthop Relat Res, 1996, (323): 31-41.
8.	Naasan A, Page RE. Duplication of the thumb. A 20-year retrospective review. J Hand Surg (Br), 1994, 19(3): 355-360.
9.	Townsend DJ, Lipp EB, Chun K, et al. Thumb duplication, 66 years’ experience—a review of surgical complications. J Hand Surg (Am), 1994, 19(6): 973-976.
10.	Lee CC, Park HY, Yoon JO, et al. Correction of Wassel type Ⅳ thumb duplication with zigzag deformity: results of a new method of flexor pollicis longus tendon relocation. J Hand Surg (Eur Vol), 2013, 38(3): 272-280.
11.	Xu YL, Shen KY, Chen J, et al. Flexor pollicis longus rebalancing: a modified technique for Wassel Ⅳ-D thumb duplication. J Hand Surg (Am), 2014, 39(1): 75-82.
12.	Wall LB, Goldfarb CA. Reconstruction for type Ⅳ radial polydactyly. J Hand Surg (Am), 2015, 40(9): 1873-1876.
13.	Tien YC, Chih TT, Wang TL, et al. Soft tissue reconstruction for type Ⅳ-D duplicated thumb: a new surgical technique. J Pediatr Orthop, 2007, 27(4): 462-466.
14.	Shen XF, Yin F, Wang J, et al. Reconstruction of Wassel Ⅳ-D radial polydactyly with a boot-shaped neurovascular island flap: A Consecutive series of 91 thumbs. J Plast Reconstr Aesthet Surg, 2020, 73(10): 1801-1805.
15.	Rogers BH, Schmieg SL, Pehnke ME, et al. Evaluation and management of preaxial polydactyly. Curr Rev Musculoskelet Med, 2020, 13(4): 545-551.

1. 高伟阳, 丁健, 周宗伟. 先天性多拇畸形的研究进展. 中国修复重建外科杂志, 2018, 32(7): 827-831.
2. Perez-Lopez LM, la Iglesia DG, Cabrera-Gonzalez M. Radial polydactyly. What’s new? Curr Pediatr Rev, 2018, 14(2): 91-96.
3. Cheng JC, Chan KM, Ma GF, et al. Polydactyly of the thumb: a surgical plan based on ninety-five cases. J Hand Surg (Am), 1984, 9(2): 155-164.
4. Wassel HD. The results of surgery for polydactyly of the thumb. A review. Clin Orthop Relat Res, 1969, (64): 175-193.
5. Manske MC, Kennedy CD, Huang JI. Classifications in brief: The Wassel classification for radial polydactyly. Clin Orthop Relat Res, 2017, 475(6): 1740-1746.
6. Lin S, Tong K, Zhang G, et al. Clinical characteristics and distribution of thumb polydactyly in South China: A retrospective analysis of 483 hands. J Hand Surg (Am), 2020, 45(10): 938-946.
7. Hung L, Cheng JC, Bundoc R, et al. Thumb duplication at the metacarpophalangeal joint. Management and a new classification. Clin Orthop Relat Res, 1996, (323): 31-41.
8. Naasan A, Page RE. Duplication of the thumb. A 20-year retrospective review. J Hand Surg (Br), 1994, 19(3): 355-360.
9. Townsend DJ, Lipp EB, Chun K, et al. Thumb duplication, 66 years’ experience—a review of surgical complications. J Hand Surg (Am), 1994, 19(6): 973-976.
10. Lee CC, Park HY, Yoon JO, et al. Correction of Wassel type Ⅳ thumb duplication with zigzag deformity: results of a new method of flexor pollicis longus tendon relocation. J Hand Surg (Eur Vol), 2013, 38(3): 272-280.
11. Xu YL, Shen KY, Chen J, et al. Flexor pollicis longus rebalancing: a modified technique for Wassel Ⅳ-D thumb duplication. J Hand Surg (Am), 2014, 39(1): 75-82.
12. Wall LB, Goldfarb CA. Reconstruction for type Ⅳ radial polydactyly. J Hand Surg (Am), 2015, 40(9): 1873-1876.
13. Tien YC, Chih TT, Wang TL, et al. Soft tissue reconstruction for type Ⅳ-D duplicated thumb: a new surgical technique. J Pediatr Orthop, 2007, 27(4): 462-466.
14. Shen XF, Yin F, Wang J, et al. Reconstruction of Wassel Ⅳ-D radial polydactyly with a boot-shaped neurovascular island flap: A Consecutive series of 91 thumbs. J Plast Reconstr Aesthet Surg, 2020, 73(10): 1801-1805.
15. Rogers BH, Schmieg SL, Pehnke ME, et al. Evaluation and management of preaxial polydactyly. Curr Rev Musculoskelet Med, 2020, 13(4): 545-551.

Next Article
Treatment of Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers with one-stage closed reduction and elastic compression fixation with double Kirschner wires

Chinese Journal of Reparative and Reconstructive Surgery

Soft tissue balance technique by flexor pollicis longus tendon transfer for Wassel Ⅳ-D thumb duplication in children

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content