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Tiourin E, Sharpe F, Kalina S, Leis AR. Surgical Reconstruction for the Triphalangeal Thumb. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5379. [PMID: 37928630 PMCID: PMC10624463 DOI: 10.1097/gox.0000000000005379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023]
Abstract
The triphalangeal thumb poses a complex reconstructive challenge to the congenital hand surgeon due to its rarity and variable anatomy. We discuss the available evidence, reporting clinical characteristics and outcomes of surgical reconstructive procedures of triphalangeal thumb alongside a representative case. The congenital hand surgeon must approach each patient with triphalangeal thumb individually to optimize the use of available tissues to maximize functional and aesthetic outcomes.
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Affiliation(s)
- Ekaterina Tiourin
- From the Department of Plastic Surgery, University of California, Irvine Medical Center, Orange, Calif
| | - Frances Sharpe
- SCPM Southern California Permanente Medical Group, Fontana, Calif
| | - Sharon Kalina
- SCPM Southern California Permanente Medical Group, Fontana, Calif
| | - Amber R Leis
- From the Department of Plastic Surgery, University of California, Irvine Medical Center, Orange, Calif
- Division of Plastic Surgery, Children's Hospital Orange County, Orange, Calif
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Anbarasan A, Takagi T, Seki A, Takayama S. Abductor pollicis brevis rerouting and first web deepening for clasped thumb deformity in arthrogryposis multiplex congenita. J Hand Surg Eur Vol 2022; 47:1039-1044. [PMID: 35647688 DOI: 10.1177/17531934221101998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Amaleswaran Anbarasan
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Takehiko Takagi
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Atsuhito Seki
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Shinichiro Takayama
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
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Abstract
Triphalangeal thumb is a rare congenital anomaly in which the thumb has three phalanges. Clinical presentation of triphalangeal thumb can vary considerably and can be present in both hands or unilateral. The thumb can be long with a finger-like appearance. The presence of clinodactyly depends on the shape of the extra phalanx varying from wedge-shaped to rectangular. Various joints, ligaments, muscles, and tendons of the first ray can be hypoplastic or absent, with varying degrees of stiffness or instability. The aim of surgical treatment is to reconstruct or correct the anatomic anomalies to obtain greater function and a more acceptable appearance. In our series, operations varied from removal of the delta phalanx with ligament reconstruction to multiple osteotomies and rebalancing of soft tissues. Results in these often complex cases can be rewarding if the surgeon has sufficient knowledge of the underlying anatomic differences. This review summarizes our current concepts of presentation and management of the triphalangeal thumb.
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Affiliation(s)
- Steven E. R. Hovius
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus University Medical Center, Rotterdam, The
Netherlands,Department of Plastic and Reconstructive
Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands,Xpert Clinic, Hand and Wrist surgery,
Rotterdam, The Netherlands,Steven E. R. Hovius, Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Center, Wytemaweg
50, 3015 GE, Rotterdam, The Netherlands.
| | - Jacob W. P. Potuijt
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus University Medical Center, Rotterdam, The
Netherlands
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Wall LB, Ezaki M, Goldfarb CA. Camptodactyly Treatment for the Lesser Digits. J Hand Surg Am 2018; 43:874.e1-874.e4. [PMID: 29691077 DOI: 10.1016/j.jhsa.2018.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 03/18/2018] [Indexed: 02/02/2023]
Abstract
Camptodactyly of the lesser digits is commonly seen in patients with arthrogryposis. The flexed posture of the digit can be functionally limiting and necessitate surgical treatment to improve grasp function. In digits with normal bony anatomy, a lateral stiletto-shaped transposition flap combined with flexor digitorum superficialis tendon release, can improve finger deformity and function.
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Affiliation(s)
- Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, and Shriners Hospital for Children, St. Louis, MO.
| | | | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, and Shriners Hospital for Children, St. Louis, MO
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Abstract
The soft tissue envelope in congenital contractural conditions such as clasped or arthrogrypotic thumbs is often deficient in 2 planes, the thumb-index web and the flexor aspect of the thumb. Small local transposition flaps borrow tissue from 1 plane to augment the other and are likely to worsen 1 contracture whereas improving the other. Tissue must be added to the thumb envelope from outside the contracted areas. A flap based on the index finger can be designed to both open the thumb-index web and augment skin on flexor aspect of the thumb metacarpophalangeal joint. This flap is particularly useful in the congenital contractural conditions that have the appearance of a small ptyerigium or increased skin in the dorso-palmar plane of the index finger. After a comprehensive release of all the tight structures, this technique for skin closure is straightforward and the donor site can usually be closed primarily.
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Affiliation(s)
- Marybeth Ezaki
- Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA.
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Abstract
Thumb hypoplasia is part of a spectrum of radial longitudinal deficiencies involving the upper limb. Systemic involvement of other organ systems is not uncommon, thus requiring a team approach to management. Because of the variety of anatomic abnormalities associated with thumb hypoplasia, clinical and intraoperative evaluation of the thumb must be precise. Effective management of thumb hypoplasia requires an understanding of the embryology, epidemiology, classification, presentation, and management options. Management, which is primarily determined by the grade of thumb hypoplasia, may include nonsurgical techniques, reconstruction, pollicization, and, recently, microsurgical procedures.
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Affiliation(s)
- Shian-Chao Tay
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Triphalangeal thumb is a thumb with 3 phalanges and has an estimated incidence of 1 in 25,000 live births. Clinical presentation of triphalangeal thumb can vary considerably. Most strikingly is the long finger-like thumb with clinodactyly, in the same plane as the fingers and may or may not present with an extra thumb. Anatomically, the extra phalanx can have different shapes, from wedge to rectangular. Furthermore, the involved joints, ligaments, muscles, and tendons of the first ray, from distal interphalangeal joint to radiocarpal joint, can be hypoplastic, malformed, or absent with varying degrees of stiffness or instability. Also, the first web can be insufficient, and radial polydactyly as well as other hand deformities can be present. The aim of surgical treatment is to try to reconstruct or correct the anatomic difference and at the same time provide a more acceptable appearance. In our series, depending on the malformation, operations varied from removal of the delta phalanx with ligament reconstruction to multiple osteotomies and rebalancing as well as pollicization. Complications are mostly related to structures that have not been reconstructed or corrected during operation. Results in these often complex cases can be rewarding if the surgeon has sufficient knowledge of the underlying anatomic differences.
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Affiliation(s)
- Steven E R Hovius
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
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Abstract
All the components of the thumb can be involved in congenital hypoplasia. Blauth's classification continues to be helpful for description of the degree of hypoplasia leading to different options of surgical reconstruction. Surgical strategy includes first web deepening, MP ligamentoplasty, thenar augmentation using tendon transfer and correction of associated abnormalities involving the extensor and flexor tendons. For grade IIIB and grade IV, recommended option for reconstruction is index finger pollicisation.
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Affiliation(s)
- G Dautel
- Service de chirurgie plastique et reconstructrice de l'appareil moteur, CHU de Nancy, hôpital Jeanne-d'Arc, BP 303, 54201, Toul cedex, France.
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Abstract
Multiple reconstructive options exist for the web space contracture: skin grafts, local flaps, and distant flaps have all been used to release the contracture and resurface the resultant defect. Local flaps are frequently more suited to web contractures between the fingers, whereas the thumb-index web space is amenable to a broader range of surgical techniques. The authors present a review of the anatomy of the web and options for reconstruction of web space contractures.
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