Wang DH, Zhang GP, Wang ZT, Wang M, Han QY, Liu FX. Pedicle complex tissue flap transfer for reconstruction of duplicated thumbs with unequal size. World J Clin Cases 2021; 9(35): 10909-10918 [PMID: 35047601 DOI: 10.12998/wjcc.v9.i35.10909]
Corresponding Author of This Article
Qin-Yi Han, MD, Doctor, Department of Hand and Foot, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Qingwuweiqi, Jinan 250021, Shandong Province, China. hanqinyi@126.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
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Wang DH, Zhang GP, Wang ZT, Wang M, Han QY, Liu FX. Pedicle complex tissue flap transfer for reconstruction of duplicated thumbs with unequal size. World J Clin Cases 2021; 9(35): 10909-10918 [PMID: 35047601 DOI: 10.12998/wjcc.v9.i35.10909]
De-Hua Wang, Zeng-Tao Wang, Meng Wang, Department of Hand and Foot, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Gui-Ping Zhang, Department of Anesthesiology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
Qin-Yi Han, Department of Hand and Foot, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
Fan-Xiao Liu, Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Author contributions: Liu FX, Wang DH, and Han QY designed the research study; Wang DH, Zhang GP, Wang ZT, Wang M, Han Q, and Liu FX performed the research; Liu FX and Han QY analyzed the data; Wang DH, Zhang GP, Wang ZT, Wang M, Han QY, and Liu FX wrote the manuscript; Liu FX and Han QY contributed equally in the planning, construction, and writing of the manuscript.
Supported bythe China Scholarship Council, No. 201808080126 (to Liu FX).
Institutional review board statement: The study was reviewed and approved by the Biomedical Ethic Committee of Shandong Provincial Hospital (Approval No. 2021-018).
Informed consent statement: Written consent was obtained from the patients’ parents for the purpose of publication of case details and images.
Conflict-of-interest statement: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: No additional data are available.
Corresponding author: Qin-Yi Han, MD, Doctor, Department of Hand and Foot, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Qingwuweiqi, Jinan 250021, Shandong Province, China. hanqinyi@126.com
Received: July 11, 2021 Peer-review started: July 11, 2021 First decision: August 18, 2021 Revised: August 22, 2021 Accepted: October 27, 2021 Article in press: October 27, 2021 Published online: December 16, 2021 Processing time: 151 Days and 21.3 Hours
Abstract
BACKGROUND
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.
AIM
To evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Core Tip: We found that 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 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. Therefore, 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.
