Free toe flank flap combined with metacarpophalangeal osteotomy and tendon insertion reconstruction for the treatment of severe lateral deviation deformity after thumb duplication
10.3760/cma.j.cn114453-20240917-00234
- VernacularTitle:游离足趾侧腹皮瓣结合掌指骨截骨及肌腱止点重建术治疗复拇畸形术后严重侧偏
- Author:
Jun GU
1
;
Jia LI
;
Fei YIN
;
Jun WANG
;
Weifeng LIN
Author Information
1. 无锡市第九人民医院小儿骨科，无锡 214000
- Publication Type:Journal Article
- Keywords:
Hand deformities, congenital;
Polydactyly;
Postoperative complications;
Flank flap of free toes;
Microsurgery
- From:
Chinese Journal of Plastic Surgery
2025;41(4):390-396
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effectiveness of a free toe lateral ventral flap combined with metacarpophalangeal (MCP) osteotomy and tendon insertion reconstruction in treating severe lateral deviation in patients with postoperative duplicated thumb deformity.Methods:A retrospective analysis was conducted on the clinical data of children with severe lateral deviation after surgery for duplicated thumb deformity, treated at the Department of Pediatric Orthopaedics of the Ninth People’s Hospital of Wuxi City from January 2018 to June 2023. The children were divided into 2 groups: the control group underwent "MCP osteotomy and tendon insertion reconstruction", which included metacarpal (or phalangeal) osteotomy with internal fixation, interphalangeal joint (IPJ) and metacarpophalangeal joint (MCPJ) arthroplasty, as well as reconstruction of the insertion points of extensor and flexor tendons, collateral ligaments, abductor pollicis tendons, and joint capsules. The treatment group, in addition to the surgical steps performed in the control group, underwent reconstruction of the asymmetric nail fold using a free lateral toe flap and digital volume augmentation. The occurrence of postoperative complications was observed and recorded, and the circumference of the digit, joint lateral deviation angle, joint range of motion, and the postoperative scar conditions of the reconstructed thumbs of the 2 groups were compared. The appearance and function of the reconstructed thumbs were evaluated by using the Japanese Society for Surgery of the Hand (JSSH) score (total score of 20), the aesthetic scoring system (ASS) (total score of 18), and the modified Tada score (total score of 8). In all three scoring systems, the higher the score, the better the postoperative outcomes. The measurement data of normal distribution were expressed as Mean±SD, and independent sample t-test was used to compare the two groups. The count data were expressed as frequency, and χ2 test was used to compare the two groups. Results:A total of 41 children were enrolled, with 25 males and 16 females, aged 9 to 18 years (mean 11.3 years, ) with a time since initial surgery ranging from 6 to 16 years (mean 10.8 years). There were 25 cases in the control group and 16 cases in the treatment group. All surgeries were successfully completed, with no postoperative complications such as infection, skin or flap necrosis, or bone nonunion occurred. All children were followed up for 10-39 months (mean of 22.1 months). Preoperative comparison of the 2 groups in terms of gender, age, side of deformity, lateral deviation angle of MCPJ, lateral deviation angle of IPJ, and circumference of the digit was comparable with no statistically significant differences. At the final follow-up, there were no statistically significant differences between the two groups in MCPJ lateral deviation angle, IPJ lateral deviation angle, MCPJ range of motion, IPJ range of motion, Vancouver scar scale score, and modified Tada score (all P>0.05). However, in the treatment group, the ratio of reconstructed-side to healthy-side phalangeal circumference (1.05±0.04 vs. 0.76±0.03), JSSH score [(17.1±0.8) points vs. (15.2±0.6) points] and ASS score [(16.6±0.7) points vs. (14.5±0.7) points] were higher than those of the control group, and the differences were statistically significant (all P<0.01). Conclusion:The combination of a free lateral toe flap with MCP osteotomy and tendon insertion reconstruction for treating severe lateral deviation after surgery for duplicated thumb deformity fully leverages the technical advantages of microsurgery. The appearance of the lateral nail fold and the digital circumference are close to normal and can restore good thumb extension and flexion function.
