Reconstruction of Wassel IV-D radial polydactyly with a boot-shaped neurovascular island flap: A Consecutive series of 91 thumbs.

Abstract

INTRODUCTION:

Reconstruction of Wassel IV-D radial polydactyly is challenging and requires a custom strategy dependent on the relative size and shape of the radial and ulnar duplicates. Herein, we describe a technique using a boot-shaped neurovascular island flap and review our outcomes.

METHODS:

Ninety-one consecutive patients had reconstruction with a boot-shaped neurovascular island flap. The flap was dissected out from the thumb to be removed. Specific flap modifications were inclusion of the lateral nail fold, Bruner incisions dorsally and volarly to reduce scarring at the interphalangeal (IP) joint and also complete mobilization of the island flap on its pedicle to allow easier inset. A flexor pollicis longus and extensor tendon rebalancing technique was used to correct the deviation of the reconstructed thumb IP joint.

RESULTS:

All boot-shaped neurovascular island flaps survived with good contour, shape, and symmetry. The average follow-up period was 25 months (range 6-60 months). Using the Japanese Society for Surgery of the Hand (JSSH) score for classification of outcomes, seven cases were classified as excellent and 84 cases as good. The median JSSH score was 18. The median Kapandji score for opposition was 9 (range 8-10).

CONCLUSION:

Using a boot-shaped neurovascular island flap completely mobilized on its pedicle with a custom strategy for each radial duplicate, good outcomes can be achieved in reconstruction of Wassel IV-D radial polydactyly.

LEVEL OF EVIDENCE:

Therapeutic Level IV.

• Authors: Xiao Fang Shen, Fei Yin, Jun Wang, Xin Zhang, Ming Yu Xue, Harvey Chim, Yong Jun Rui
• Journal: Journal of plastic, reconstructive & aesthetic surgery : JPRAS (J Plast Reconstr Aesthet Surg) Vol. 73 Issue 10 Pg. 1801-1805 (Oct 2020) ISSN: 1878-0539 [Electronic] Netherlands
• PMID: 32565137 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Topics

• Child, Preschool
• Female
• Humans
• Infant
• Male
• Polydactyly (classification, surgery)
• Plastic Surgery Procedures (methods)
• Surgical Flaps (blood supply, innervation)
• Thumb (abnormalities, surgery)