Surgical techniques for reconstruction of the hypoplastic thumb

Mende, Konrad; Suurmeijer, J Annelie; Tonkin, Michael A.

doi:10.1177/1753193418793579

Cited by 14 publications

(26 citation statements)

References 32 publications

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“…Surgical methods for reconstruction have previously been described by Tonkin (2011) and Mende et al (2019). The detailed surgical procedures for each patient are listed in Table 1.…”

Section: Surgical Techniquementioning

confidence: 99%

A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia

Mende

Suurmeijer

Mason

et al. 2021

J Hand Surg Eur Vol

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This retrospective study analyses long-term outcomes of reconstruction for congenital thumb hypoplasia Grades 2 and 3 A. In 22 thumbs (mean follow-up 9 years), instability of the metacarpophalangeal joint was found in 20 thumbs regardless of the method of reconstruction, double breasting of local tissue with or without adductor pollicis advancement or use of a slip of flexor digitorum superficialis to supplement local tissue. There was a trend towards a greater global strength, higher Kapandji score and better subjective function score when the abductor digiti minimi was used as an opposition transfer as compared with the flexor digitorum superficialis. Results for motion and subjective parameters were consistent with comparable studies though these comparisons are compromised by different methods of classification and assessment. Consistent application of an expanded Blauth grading system and a formal hypoplastic thumb score will improve the ability to compare pre- and postoperative status, different techniques and results from different centres. Level of evidence: IV

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“…Surgical methods for reconstruction have previously been described by Tonkin (2011) and Mende et al (2019). The detailed surgical procedures for each patient are listed in Table 1.…”

Section: Surgical Techniquementioning

confidence: 99%

A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia

Mende

Suurmeijer

Mason

et al. 2021

J Hand Surg Eur Vol

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“…Most of the hand surgeons across the globe prefer pollicization of index to provide a satisfactorily functioning thumb. [6][7][8] But in most of the Asian countries including India, Fig. 5 North Coast Pinch Gauge, which was used to assess the pulp to pulp and lateral grip strengths after thumb reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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

Balakrishnan

Vijayaragavan²,

Somesh³

2020

Indian J Plast Surg

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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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“…The difference between subtypes IIa, IIb, and IIc are related to the instability of the MCP joint. For IIc, instability occurs on several planes and reconstruction is difficult [21]. Recommendations by Smith et al [4] for grade II hypoplasia treatment include that IIa has to be reconstructed with FDS from the fourth finger through bone fixation, and for IIb, MCP joint arthrodesis and Huber opponensplasty, and for IIc, tendon transfer and ADM transfer [4,19].…”

Section: Methodsmentioning

confidence: 99%

“…Recommendations by Smith et al [4] for grade II hypoplasia treatment include that IIa has to be reconstructed with FDS from the fourth finger through bone fixation, and for IIb, MCP joint arthrodesis and Huber opponensplasty, and for IIc, tendon transfer and ADM transfer [4,19]. Mende, Suurmeijer, and Tonkin [21] recommended performing pollicization for grade IIc because of the multiaxial instability of the MCP joint.…”

Section: Methodsmentioning

confidence: 99%

Methods for Congenital Thumb Hypoplasia Reconstruction. A Review of the Outcomes for Ten Years of Surgical Treatment

2019

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Background and objectives: Congenital thumb hypoplasia is a rare deformity of upper extremity. The incidence for thumb hypoplasia grade II–V is 1:10,000 newborns per year in Latvia. A technique for extensor indicis proprius (EIP) tendon transfer with subperiosteal fixation was developed and used for thumb hypoplasia grades II and IIIa. Pollicization or second-toe-to-hand transplantation with metatarsophalangeal (MTP) joint arthrodesis was used for the reconstruction of hypoplasia grade IIIb–V. The aim of this retrospective cohort study is to evaluate the outcomes for reconstruction techniques used in one surgical center during a ten-year period by one surgeon to evaluate functional and aesthetical outcomes for new techniques. Materials and Methods: In total, 21 patients were operated on during 2007–2017, and 18 of these patients were involved in this study. Long-term follow-up was completed to evaluate the functions and aesthetics of the hands. Results: disabilities of the arm, shoulder and hand (DASH) was 9.35 (8–10.7) for the second-toe-to-hand with MTP joint arthrodesis transplantation method for pollicization method 19.8 (6–26.7), and for the EIP tendon transposition, 14.54 (0.9–56.3). Conclusions: The postoperative functional parameters of congenital hand hypoplasia patients, regardless of the surgical method, are worse than the functional results of healthy patients. The use of the second-toe-to-hand with MTP joint arthrodesis transplantation method provides patients with congenital hand IIIb–V hypoplasia a stable and functional first finger formation. The functional results are comparable to the clinical results of the pollicization method while ensuring the creation of a five-digit hand.

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Surgical techniques for reconstruction of the hypoplastic thumb

Cited by 14 publications

References 32 publications

A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia

A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia

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

Methods for Congenital Thumb Hypoplasia Reconstruction. A Review of the Outcomes for Ten Years of Surgical Treatment

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