To present a surgical technique of combining the on-top plasty with modified Bilhaut-Cloquet procedure for reconstructing a rare type of complicated radial polydactyly and evaluate the outcomes.

Fourteen complicated radial polydactyly in 13 patients were corrected by combining the on-top plasty with modified Bilhaut-Cloquet procedure. Osteotomies were performed as required, and the acral part of the ulnar thumb was transposed onto the proximal part of the radial thumb. The distal parts of the two thumbs were isolated as neurovascular pedicled composite tissue flaps, including part of the distal phalanx and nail bed, and were attached together in an extra-articular way. The tendons were rebalanced, and the nail bed was reconstructed. Objective and subjective outcomes were assessed.

The average follow-up time was 32.4 months (6-60 months). All reconstructed thumbs were rated as good in appearance and function. The mean Vancouver Scar Scale score was 1.3 (range 1-2) and the mean Wang-Gao score of the reconstructed thumbnail was 9.4 (range 8-11). The Tada score for the function of the reconstructed thumb was 5.5 (range 5-6). The main active range of motion (ROM) of the interphalangeal joint (IPJ) was 2.1-38.9°. All parents were satisfied with the outcomes.

Because of the diverse manifestations of thumb polydactyly, individualized surgical treatment is recommended, and careful preoperative planning should be made with the principle of combining the best parts of the two thumbs. By combining an on-top plasty with modified Bilhaut-Cloquet procedure, a satisfactory result can be achieved for treating complicated radial polydactyly.

Background: There are numerous flaps described for the treatment of fingertip amputation. Most flaps do not address the shortened nail resulting from amputation. Proximal nail fold (PNF) recession is a simple procedure that exposes the hidden portion of the nail and improves the aesthetic appearance of an amputated fingertip. The aim of this study is to measure the size and aesthetic outcomes of the nail following fingertip amputation in patients treated with PNF recession compared to those treated without PNF recession. Methods: This study was conducted between April 2016 and June 2020 and included patients with a digital-tip amputation who underwent a local flap or shortening closure for reconstruction. All suitable patients were counselled for PNF recession. In addition to demographic, injury and treatment data, the length and area of the nail were measured. The outcomes were assessed at a minimum of 1 year after surgery and included measurement of the size of the nail, patient satisfaction and aesthetic outcomes. A comparison of the outcomes was done between patients who underwent PNF recession versus those who did not. Results: Out of 165 patients treated for fingertip injury, 78 underwent PNF recession (Group A) and 87 did not undergo PNF recession (Group B). In Group A, the nail length was 72.54% (SD: 14.4) and the nail plate area was 74.35% (SD: 13.96) compared to the contralateral uninjured nail. These results were significantly better (p = 0.000) compared to Group B where the values were 36.49% (SD: 8.45) and 35.8% (SD: 8.4), respectively. The patient satisfaction and aesthetic outcome scores were also significantly higher in Group A patients (p = 0.002). Conclusions: The size and aesthetic outcomes of the nail following fingertip amputation in patients treated with PNF recession are better compared to those treated without PNF recession. Level of Evidence: Level III (Therapeutic).

Background  There are numerous flaps described for the treatment of fingertip amputation. Shortened nail length resulting from amputation is an ignored area. Eponychial flap is a simple procedure that helps to lengthen the nail plate and correct this deformity. Methods  This case-control study was conducted between April 2016 and June 2020 aimed at comparing the outcome of nail defects in a fingertip amputation treated with eponychial flap and those treated without an eponychial flap. Results  Among 165 patients treated for fingertip injury, 78 were treated with eponychial flap (group A) and 87 without eponychial flap (group B). In group A, the nail length was 72.54% (standard deviation [SD]: 14.4) and the nail plate area was 74.35% (SD: 13.96) compared with the contralateral uninjured nail. These results were significantly better ( p  = 0.000) compared with group B where the values were 36.49 (SD: 8.45) and 35.8% (SD: 8.4), respectively. The aesthetic outcome score was also significantly higher in group A patients ( p  = 0.002). The patient satisfaction was superior in group A compared with group B. Conclusion  The eponychial flap is a simple and reliable technique that can be used to restore the visible nail length in traumatic fingertip defects. Compared with fingers treated without nail lengthening with eponychial flap gives excellent aesthetic results.

Thumb polydactyly is one of the most common congenital hand deformities, and the Bilhaut-Cloquet procedure or a modified one is often used. However, controversy remains over the rare instances in which both thumbs are not of similar length or far apart in distance.

To evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.

From January 2014 to December 2020, 15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery center. The technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in distance. Subjective parents' evaluations and functional outcomes (ALURRA and TATA criteria) were obtained. The alignment deviation, instability, range of motion (percent of opposite thumb) of the interphalangeal and metacarpophalangeal joints, and the aesthetic aspects, including circumference, length, nail size, and nail deformity, were used to assess the clinical outcomes.

The average age of patients at the time of surgery was 13 mo, and the mean final follow-up occurred at 42 mo. An appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed thumbs. An unstable interphalangeal joint occurred in one thumb. The flexion-extension arc at the metacarpophalangeal joint was good, while that at the interphalangeal joint was poor. Most of the parents were satisfied with the cosmetic and functional results of the reconstructed thumbs. The mean ALURRA score was 21.8 (range: 20-24), and the Tada score was 6.9 (range: 5-8). Compared with the non-operated side, the length of the operated thumb was approximately 95%, the girth was 89%, and the nail width was 82.9%. The mean ranges of motion were 62.1% of that of the unaffected thumb in the interphalangeal joint and 78.3% in the metacarpophalangeal joint.

Harvesting a pedicle flap from a severed thumb is a safe and reliable procedure. Defects of the preserved thumb, such as the skin, nail, and bone, can be effectively restored using the complex tissue flap.

To evaluate nail appearance after nail fusion plasty to treat thumb duplication.

A modified form of nail fusion plasty was performed on 17 reconstructed thumbs of 16 children with thumb duplications, commencing in January 2010. We assessed nail width and nail, lunular, and nail fold deformities using the Wang-Gao scoring system. All 17 thumbs were evaluated over an average of 32 months (range, 12-48 months) of follow-up.

One patient with bilateral thumb deformities was excluded. The width ratios of 15 reconstructed nails (compared with those of the contralateral thumbs) were 82-118% (average, 97%). Nine thumbs exhibited nail ridges or gaps; the average ridge/gap score was 1.23 (maximum, 2). Six thumbs exhibited lunular deformities; the average score was 1.58 (maximum, 2). Another six thumbs evidenced nail fold deformities; the average score was 1.64 (maximum, 2). Only one thumb exhibited nail dehiscence. Two thumbs had no nail deformity. The final assessments were excellent in 14 cases, good in 2 cases, and fair in 1 case.

We could not significantly reduce the deformity rate of the nail plate, nail fold, or lunula using our new technique, but the deformities were much less marked than previously. Nail fusion plasty usefully enlarges the nail and pulp in patients with hypoplastically duplicated thumbs.

Surgery is still the main treatment for congenital polydactyly, and the aim of surgical reconstruction is to obtain a thumb with excellent function and appearance. A systematic assessment of polydactyly is required prior to surgery, including bone stress lines, joint deviation, joint activity and joint instability, size and development of finger and nail. Bone shape, joint incongruency, and abnormal tendon insertions must be corrected completely, in order to obtain good function and to avoide secondary surgery. Bilhault-Cloquet procedure can reconstruct the size of the finger and nails. Fine manipulation can improve the postoperative nail deformity, so that the reconstructed nail reaches a satisfactory aesthetic score.

This study was designed to evaluate thumb growth after surgical management of a duplicate thumb and investigate its developmental pattern.

We compared the thumbs and index fingers of 486 normal children (aged 1-18 y) (group A) with 15 children showing radial polydactyly (group B). All duplicate thumbs were treated with excision of the radial thumb and reconstruction of the ulnar thumb. Radiographs of groups A and B were used to compute the thumb-to-index finger length ratio and width ratio, and the thumb-to-index finger phalanx length ratio and phalanx width ratio.

In group A, the length ratio, width ratio, phalanx length ratio, and phalanx width ratio did not change with age, and remained constant in males and females. In group B, after an average follow-up period of 41.0 months, the original findings were also similar to the final ratios. In group B, only the phalanx width ratio was obviously smaller than normal.

A permanent developmental stability exists between the thumb and the index finger, even in patients with radial polydactyly. The development of the retained digit is not influenced by the ablation of the extra digit.

Therapeutic IV.