Severe congenital thumb hypoplasia: "four" or "five" ? Classification and surgical techniques
10.3760/cma.j.cn114453-20210909-00381
- VernacularTitle:"4"或"5"？重度先天性拇指发育不良的分型与治疗进展
- Author:
Yunhao XUE
1
;
Shanlin CHEN
Author Information
1. 北京积水潭医院手外科 100035
- Keywords:
Hand deformities;
Reconstructive surgical procedures;
Congenital thumb hypoplasia
- From:
Chinese Journal of Plastic Surgery
2021;37(9):953-961
- CountryChina
- Language:Chinese
-
Abstract:
Congenital thumb hypoplasia is a rare congenital limb deformity, which has major impact on hand and upper limb functions. Since Buck-Gramcko published the classic literature on index finger pollicization, it has become the standard technique for the treatment of severe thumb dysplasia. This technique is also recognized as one of the milestones in the history of hand surgery. Blauth classification and later modified classification are proposed to find a designated point that separates "thumb preservation with functional reconstruction" and "index finger pollicization" . It has been repeatedly established that "index finger pollicization should be the first option" . But in reality, regardless of race, culture or country, most parents would still prefer surgeons to preserve the thumb, even if the functions are somewhat compromised. For them, "five is better than four under any circumstances" . Over the past ten years, our team has treated more than nearly 300 cases of Manske type 3-4 thumb dysplasia. For everyone of them, we had a detailed preoperative consultation and demonstrated the photos of the post-pollicization thumb that presented unparalleled functions. Nevertheless, after reviewing the postoperative photos of the cases of thumb preservation, 90% of the parents still insisted on keeping the thumb. "4" or "5" is not just a matter of numbers, but more of a complicated conundrum of philosophy, psychology and ethics, like many other clinical dilemmas. Anytime when physicians’ own preferences are inconsistent with the patients’, it is up to the physicians’ to listen and make compromises accordingly. The major principles of thumb hypoplasia treatment and surgical details were summarized in this manuscript. It is our intention that such comprehensive guidelines could be helpful to our colleagues in the same field.
