Double dorsal-lateral rotation flap for the treatment of congenital clasped thumb
10.3760/cma.j.cn114453-20210905-00374
- VernacularTitle:双指背侧方旋转皮瓣治疗先天性扣拇畸形
- Author:
Pengcheng LI
1
;
Shanlin CHEN
;
Bo LIU
;
Chang LIU
;
Zhixin WANG
Author Information
1. 北京积水潭医院手外科，北京 100035
- Keywords:
Hand deformities, congenital;
Thumb;
Surgical flaps;
Clasped thumb;
Rotation flap;
First web contracture;
Palmar thumb defect
- From:
Chinese Journal of Plastic Surgery
2022;38(3):299-303
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To introduce a new design of double rotation flap in the treatment of congenital clasped thumb. The clinical effect of this new method to deepen the thumb-index webspace and release the palmar contracture of the first metacarpophalangeal joint (MCP) was assessed.Methods:Retrospective analysis was performed on the data of children with congenital clasped thumb treated by hand surgery in Beijing Jishuitan Hospital from January 2017 to December 2020. All patients presented with a narrow thumb-index webspace and palmar contracture at the first MCP joint. The double rotation flap contains two components, one of which was harvested from the radial-dorsal side of the index and transferred to widen the first webspace. The volar defect was mainly covered by the rotation flap transposed from the ulnar-dorsal side of the thumb. The extensor pollicis brevis was tightened or reconstructed based on the various developmental abnormality and the intrinsic muscle contracture was released to facilitate passive extension of the first MCP joint. Postoperative plaster immobilization was applied for one month and regular rehabilitation was conducted afterward. The survival of the flaps and the healing of the donor sites were followed up, the effect of the first webspace and palmar contracture release and thumb function were evaluated, and the parents’ satisfaction was investigated.Results:A total of 10 children with 11 affected thumbs (4 on the left side and 7 on the right side) were enrolled, with an average age of 26 months (11-36 months). All transposition flaps were survived without tip necrosis. Based on Gilbert’s method of assessment of thumb function, excellent or good improvement was achieved in the abduction of thumb (42°, 38°-43°) and extension of the MCP joint (1.6°, -5°-10°). All parents were satisfied with the appearance and function of the affected hand.Conclusions:The double dorsal-lateral rotation flap can provide sufficient width and depth of the first webspace and adequate coverage of the volar defect of the first MCP joint. This simple design is a reliable procedure for the treatment of congenital clasped thumb.
