The incidence of polydactyly accounts for 14.3% of congenital malformations of the hand, of which polydactyly of the thumb accounts for nearly 50% Wuping County Hospital Department of Restoration and Reconstruction Surgery practice to true
The causes of repetitive thumb deformity can be (1) excessive segmentation of the hand plate during embryonic process, and the related influencing factors are not well defined; (2) genetic factors, and the genetic loci have been defined.
Repetitive thumb deformities can occur both preaxially (radial) and postaxially (ulnar), with preaxial repetitive thumb deformities being more common in Asians.
There are various methods for typing repetitive thumb deformities, the most common being the Wassel typing [[i]], most commonly type IV, which accounts for approximately 50% of cases. there are different adaptations and modifications of the Wassel typing, but the basic typing principles are the same. Kenya Tsushita [ [ii] ] subdivided type IV into types A, B, and C, and type VII into types A, B, C, and D. Wang Shuhuan and Gu Yudong [[iii]] divided it into five types: (i) drifting thumb; (ii) carpometacarpal type; (iii) metacarpophalangeal type; (iv) interphalangeal type; and (v) phalangeal type. Wang Wei [[iv]] classified compound thumb deformity into ten types according to X-ray.
(Image cited from Li Bingwan, translated by Kenya Tsushita, Practical Hand Surgery)
The timing of surgery for duplicated thumb deformity requires individualized consideration, including at least (1) the degree of development-surgical identification of tissue structure, (2) the need to damage the epiphysis, (3) the developmental impact of the duplicated thumb on the primary finger, (4) the psychological impact of the deformity, and (5) the patient’s expectations.
Hint: Before deciding on surgery, the information needed includes at least (1) the appearance of the deformity, including the ability to abduct the thumb, (2) x-rays, (3) age and health status
Tip: Surgery for polydactyly requires attention to function, appearance, plastic surgery philosophy, microsurgery philosophy
Our philosophy.
Polydactyly surgery: not simple, only precise
Timing of surgery: after 1 year of age, as early as possible
Typical cases (type IV)
Case 1 young child, fine repair can be seen
Case 2 child, standard photo of flap appearance, plastic surgery concept
Case 3 Adult, you can see the redundant finger occupying the main finger.
Case 4 This is a deformity after a polydactyly surgery more than 10 years ago, the surgery is not clear
We are now performing corrective surgery of the bone and joint and soft skin tissue, and have prepared two sets of surgical plans
[i] Wassel HD. The results of surgery for polydactly of the Thumb. A review[J].Clin Orthop Relat Res, 1969, 64: 175-193.
[ii] Tsushita KENYA, Lee BW. Practical hand surgery. 1st ed. Changchun:Jilin People’s Publishing Du. 1990,558-559.
[iii] Gu YD, Wang SHUHUAN, SENG DE, eds. Surgery of the hand [M]. Shanghai Science and Technology Press, 2002:833
[iv] Wang W, Hu H-T, Zou Y-H, et al. Classification and treatment of compound thumb deformities [J]. Chinese Journal of Reconstructive Surgery, 1988, (1).