Background:The predominant method for Manske type ⅢB and Ⅳ thumb hypoplasia is pollicization.However,for those who are not willing to sacrifice the index finger,a method that could reconstruct a functionally capable...Background:The predominant method for Manske type ⅢB and Ⅳ thumb hypoplasia is pollicization.However,for those who are not willing to sacrifice the index finger,a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable.This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative.Methods:From May 2014 to January 2017,15 patients with Manske type ⅢB or Ⅳ thumb hypoplasia who were admitted to the Department of Hand Surgery,Beijing Jishuitan Hospital were included in this study.An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint.The donor site was reconstructed by a split half of the third metatarsal.Various functional reconstructions were commenced at second stage.The reconstructed thumbs were evaluated using the Kapandji score,pinch force,and the capacities of performing daily activities through a detailed questionnaire.Results:Among these 15 patients(seven type ⅢB and eight type Ⅳ),there were ten boys and five girls with median age of 4.2 years(range:2.0–7.0 years).There were seven right,three left,and five bilateral thumbs for whom only the right thumb received surgery.There were 14 metatarsal flaps survived(14/15).With an average follow-up of 19.2 months,the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function.All 15 children have improved the Kapandji score(from 0 to an average of 6.7),pinch force(from 0 to an average of 1.5 kg),with ability of grip and pen holding.X-ray indicated continuous bone growth.Patients and parents had good acceptance of the new thumb.Conclusions:Reconstruction of an unstable hypoplastic thumb(Manske type ⅢB and Ⅳ)with use of a vascularized metatarsal is an effective strategy.I展开更多
Background:Congenital thumb deformities account for one-third or more of all cases of congenital hand deformity.However,the current classification schemes of congenital thumb hypoplasia are no longer adequate due to t...Background:Congenital thumb deformities account for one-third or more of all cases of congenital hand deformity.However,the current classification schemes of congenital thumb hypoplasia are no longer adequate due to their lack of adaptability to increasing knowledge in the field.Hence,a modified system with the potential to adapt to ongoing advances in knowledge and understanding is desperately needed.Methods:Based on the photographs collected from thousands of cases of congenital deformities of the hand and upper limb over multiple decades in our department,we subdivided thumb hypoplasia according to the variables of morphological characteristics,anatomical structures,functional status,the relationship between thumb deformity and hand deformity,the relationship between congenital hand deformity syndrome and thumb hypoplasia,and the selection of treatment methods.Results:A total of 10 types were presented,which were elucidated with nomenclatures as well as pathological feature and symptoms.Conclusion:This modified system may shed additional light on the classification of congenital thumb anomalies,which will assist in a more effective selection of treatment modalities and offers significant benefits to both patients and practice.展开更多
文摘Background:The predominant method for Manske type ⅢB and Ⅳ thumb hypoplasia is pollicization.However,for those who are not willing to sacrifice the index finger,a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable.This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative.Methods:From May 2014 to January 2017,15 patients with Manske type ⅢB or Ⅳ thumb hypoplasia who were admitted to the Department of Hand Surgery,Beijing Jishuitan Hospital were included in this study.An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint.The donor site was reconstructed by a split half of the third metatarsal.Various functional reconstructions were commenced at second stage.The reconstructed thumbs were evaluated using the Kapandji score,pinch force,and the capacities of performing daily activities through a detailed questionnaire.Results:Among these 15 patients(seven type ⅢB and eight type Ⅳ),there were ten boys and five girls with median age of 4.2 years(range:2.0–7.0 years).There were seven right,three left,and five bilateral thumbs for whom only the right thumb received surgery.There were 14 metatarsal flaps survived(14/15).With an average follow-up of 19.2 months,the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function.All 15 children have improved the Kapandji score(from 0 to an average of 6.7),pinch force(from 0 to an average of 1.5 kg),with ability of grip and pen holding.X-ray indicated continuous bone growth.Patients and parents had good acceptance of the new thumb.Conclusions:Reconstruction of an unstable hypoplastic thumb(Manske type ⅢB and Ⅳ)with use of a vascularized metatarsal is an effective strategy.I
文摘Background:Congenital thumb deformities account for one-third or more of all cases of congenital hand deformity.However,the current classification schemes of congenital thumb hypoplasia are no longer adequate due to their lack of adaptability to increasing knowledge in the field.Hence,a modified system with the potential to adapt to ongoing advances in knowledge and understanding is desperately needed.Methods:Based on the photographs collected from thousands of cases of congenital deformities of the hand and upper limb over multiple decades in our department,we subdivided thumb hypoplasia according to the variables of morphological characteristics,anatomical structures,functional status,the relationship between thumb deformity and hand deformity,the relationship between congenital hand deformity syndrome and thumb hypoplasia,and the selection of treatment methods.Results:A total of 10 types were presented,which were elucidated with nomenclatures as well as pathological feature and symptoms.Conclusion:This modified system may shed additional light on the classification of congenital thumb anomalies,which will assist in a more effective selection of treatment modalities and offers significant benefits to both patients and practice.
