One-stage thumb opponensplasty and polygonal flap in congenital spade hand reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHEN Xiaofang , YIN Fei , XUE Mingyu , YU Jiong , LIN Weifeng ,  RUI Yongjun

Department of Pediatric Orthopaedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214000, P.R.China;

Corresponding?author：

RUI Yongjun, Email: ruiyj@hotmail.com

Keywords：

Congenital spade hand deformity; metacarpal osteotomy; thumb opponensplasty; the first web formation; surgical flaps

DOI：

10.7507/1002-1892.201804111

Video：

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Objective To explore the effectiveness of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap reconstruction in the treatment of congenital spade hand deformity. Methods Eight cases of congenital spade hand were treated between January 2013 and March 2017. There were 5 males and 3 females, with an average age of 17.5 months (range, 13-35 months). The clinical manifestations of all the children were congenital spade hand and the affected hand was shorter than the healthy side. The contralateral hand was normal and there was no chest, skull, or facial deformity. The operation was performed with metacarpal osteotomy and thumb opponensplasty, and through the dorsal metacarpal rectangular flap to reconstruct the first web and through rotation of polygonal skin flap to reconstruct thumb web and lateral fold of thumb index nail. The dorsal ulnar and proximal radial segment of thumb were repaired by skin grafting. A vernier caliper was used to measure the first web space and the thumb function was evaluated by modified Tada score. Results The reconstruction of palmar function and the formation of first web were completed in one stage in 8 children. Skin grafting on the dorsal ulnar side of thumb and radial side of index finger survived after operation. All the children were followed up 13-29 months, with an average of 16.1 months. There was no infection, skin flap necrosis, lateral deviation of thumb, scar contracture, or other complications. At last follow-up, there was no significant difference in skin color between the healthy side and the first web of the affected hand. The opening distance of first web space was 3.5-5.0 cm, with an average of 4.2 cm. According to the modified Tada scoring system, the results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. The thumb could grasp and pinch actively, and the palm opposition function was good. Conclusion One-stage thumb opponensplasty combined with polygonal flap for reconstruction of congenital spade hand deformity can improve hand function very well. The reasonable designing of skin flap can effectively cover important areas, and the operation is safe and reliable.

Citation： SHEN Xiaofang, YIN Fei, XUE Mingyu, YU Jiong, LIN Weifeng, RUI Yongjun. One-stage thumb opponensplasty and polygonal flap in congenital spade hand reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(2): 199-202. doi: 10.7507/1002-1892.201804111 Copy

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3.	孫麗穎, 田文, 趙俊會, 等. 先天性復拇畸形虎口形態特點及治療策略. 中華手外科雜志, 2016, 32(6): 430-433.
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6.	高偉陽, 石瑋, 丁健, 等. 推移島狀復合組織瓣重建發育不良性復拇畸形指體. 中華整形外科雜志, 2016, 32(5): 321-327.
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8.	劉育杰, 丁小珩, 張宏勛, 等. 掌背側菱形推進皮瓣在先天性并指治療中的應用. 中華手外科雜志, 2011, 27(4): 211-213.
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11.	金光哲, 王凱, 熊勝, 等. 伴有虎口區皮膚缺損的拇指缺損再造. 中華手外科雜志, 2016, 32(5): 334-335.
12.	魏誠, 巨積輝, 金乾衡, 等. 第一掌背動脈島狀皮瓣修復虎口瘢痕攣縮. 中華手外科雜志, 2018, 34(2): 141-142.
13.	王斌, 王輝, 孟釗, 等. Ilizarov 技術在拇指脫套傷截指術后功能重建中的應用. 中國修復重建外科雜志, 2018, 32(12): 1545-1548.
14.	高偉陽, 丁健, 王安遠. 改良指甲、骨關節和切口成形技術的 Bilhaut-Cloquet 術治療多拇畸形. 中華骨科雜志, 2016, 36(16): 1033-1043.
15.	張子陽, 唐修俊, 魏在榮, 等. 保留踇展肌的改良游離足底內側皮瓣修復手掌部瘢痕攣縮畸形. 中國修復重建外科雜志, 2018, 32(7): 951-954.
16.	劉波, 何百昌, 謝永廉, 等. 島狀組織瓣重建發育不良多拇畸形及美學評價. 中華手外科雜志, 2016, 32(3): 178-180.
17.	田文, 楊勇. 手部先天畸形的治療原則應兼顧手部的外觀和功能. 中國骨與關節雜志, 2017, 6(4): 241-243.
18.	沈小芳, 印飛, 芮永軍, 等. 小兒指間關節融合型復拇畸形診治體會. 中國修復重建外科雜志, 2018, 32(10): 1317-1320.

1. 田文, 趙俊會, 田光磊, 等. 先天性復合性并指畸形. 中華手外科雜志, 2007, 23(2): 82-84.
2. 徐蘊嵐, 沈愷穎, 王志剛. 兒童 WasselⅣ-4 型復拇畸形手術療效分析. 中華小兒外科雜志, 2012, 33(11): 846-849.
3. 孫麗穎, 田文, 趙俊會, 等. 先天性復拇畸形虎口形態特點及治療策略. 中華手外科雜志, 2016, 32(6): 430-433.
4. Chang J, Danton TK, Ladd AL, et al. Reconstruction of the hand in Apert syndrome: a simplified approach. Plast Reconstr Surg, 2002, 109(2): 465-471.
5. Ghani HA. Modified dorsal rotation advancement flap for release of the thumb web space. J Hand Surg (Br), 2006, 31(2): 226-229.
6. 高偉陽, 石瑋, 丁健, 等. 推移島狀復合組織瓣重建發育不良性復拇畸形指體. 中華整形外科雜志, 2016, 32(5): 321-327.
7. 印飛, 芮永軍, 薛明宇, 等. 指動脈順行筋膜瓣在 Wassel Ⅳ-D 型復拇畸形美學修復中的應用. 中國修復重建外科雜志, 2018, 32(9): 1201-1204.
8. 劉育杰, 丁小珩, 張宏勛, 等. 掌背側菱形推進皮瓣在先天性并指治療中的應用. 中華手外科雜志, 2011, 27(4): 211-213.
9. Green DP, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery. 7th eds. Philadelphia: Elsevier, 2017: 1217-1232.
10. 陳彥名, 唐舉玉, 謝松林, 等. 腓腸內側動脈穿支皮瓣游離移植修復重度虎口瘢痕攣縮. 中華手外科雜志, 2017, 33(3): 190-192.
11. 金光哲, 王凱, 熊勝, 等. 伴有虎口區皮膚缺損的拇指缺損再造. 中華手外科雜志, 2016, 32(5): 334-335.
12. 魏誠, 巨積輝, 金乾衡, 等. 第一掌背動脈島狀皮瓣修復虎口瘢痕攣縮. 中華手外科雜志, 2018, 34(2): 141-142.
13. 王斌, 王輝, 孟釗, 等. Ilizarov 技術在拇指脫套傷截指術后功能重建中的應用. 中國修復重建外科雜志, 2018, 32(12): 1545-1548.
14. 高偉陽, 丁健, 王安遠. 改良指甲、骨關節和切口成形技術的 Bilhaut-Cloquet 術治療多拇畸形. 中華骨科雜志, 2016, 36(16): 1033-1043.
15. 張子陽, 唐修俊, 魏在榮, 等. 保留踇展肌的改良游離足底內側皮瓣修復手掌部瘢痕攣縮畸形. 中國修復重建外科雜志, 2018, 32(7): 951-954.
16. 劉波, 何百昌, 謝永廉, 等. 島狀組織瓣重建發育不良多拇畸形及美學評價. 中華手外科雜志, 2016, 32(3): 178-180.
17. 田文, 楊勇. 手部先天畸形的治療原則應兼顧手部的外觀和功能. 中國骨與關節雜志, 2017, 6(4): 241-243.
18. 沈小芳, 印飛, 芮永軍, 等. 小兒指間關節融合型復拇畸形診治體會. 中國修復重建外科雜志, 2018, 32(10): 1317-1320.

Chinese Journal of Reparative and Reconstructive Surgery

One-stage thumb opponensplasty and polygonal flap in congenital spade hand reconstruction

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