WORLD JOURNAL OF PLASTIC SURGERY
مجله جهانی جراحی پلاستیک
WJPS
Medical Sciences
http://wjps.ir
1
admin
2228-7914
2252-0724
8
10.61186/wjps
14
8888
13
en
jalali
1397
10
1
gregorian
2019
1
1
8
1
online
1
fulltext
en
Reconstruction of A Type IIIB Hypoplastic Thumb with A Huber Opposition Transfer in A Five-Year-Old Girl: Redefining Surgical Treatment
تخصصي
Special
گزارش مورد
case report
<p>Thumb hypoplasia, a congenital deficiency of bony and soft tissue of thumb, is often associated with systemic syndromes like Holt-Oram syndrome, and is the second most common thumb anomaly after duplicated thumb. It has traditionally been classified into six categories, which help guide treatment including reconstruction versus pollicization (transfer of the index finger to thumb). Amputation of the thumb and pollicization is the traditional treatment for a IIIB hypoplastic thumb. A five-year-old girl presented with a classic type IIIB hypoplastic thumb in which she has absent motor function, aplasia of the metacarpal, shortened first web space, and an unstable but present carpometacarpal (CMC) joint. Instead of amputation, the thumb was reconstructed by capsulodesis to stabilize the CMC joint, Huber Transfer Opponensplasty and abductor pollicis longus transfer to restore motor function, W-plasty to deepen the first web space, and distraction to lengthen the metacarpal. The patient tolerated the multi-stage reconstruction and bony distraction well. She was followed for one year postoperatively and has demonstrated a functional thumb. This case questions the surgical algorithm for hypoplastic thumbs and suggests a revised classification system for hypoplastic thumbs which would further divide class III based on not only the stability of the CMC joint but the presence or absence of the joint as well. We propose that amputation be reserved for type III hypoplastic thumbs in which the CMC joint is absent, (revised class IIIC) and reconstruction be attempted when the joint is present irrespective of stability (revised classes IIIA and IIIB).</p>
Congenital hand deformity, Hypoplastic thumb, Huber opposition transfer
97
102
http://wjps.ir/browse.php?a_code=A-10-312-2&slc_lang=en&sid=1
Joseph
Ricci
dr.joseph.ricci@gmail.com
10031947532846006507
10031947532846006507
Yes
Brigham and Women's Hospital Division of Plastic Surgery, Harvard Medical School
Naman
Desai
ndesai2@gmail.com
10031947532846006508
10031947532846006508
No
Brigham and Women's Hospital Department of Radiology, Harvard Medical School