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[Soft tissue reconstruction for secondary deformity after correction of Wassel type IV-D thumb duplication]
Guo-Xin Nan1, Yu-Xi Su, Wen-Quan Cai
1Orthopedic Department II, Children' s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China.
Insights
Soft tissue reconstruction effectively treats secondary deformities in Wassel type IV thumb duplication. Post-operative bracing is crucial for preventing recurrence and improving outcomes in pediatric patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Hand Surgery
- Congenital Hand Anomalies
Context:
- Wassel type IV thumb duplication is a complex congenital anomaly.
- Secondary deformities can arise after initial surgical correction.
- These deformities impact hand function and aesthetics.
Purpose:
- To evaluate the efficacy of soft tissue reconstruction for secondary deformities post-Wassel type IV thumb duplication correction.
- To identify key surgical techniques for addressing these complex cases.
- To assess the role of post-operative bracing in preventing recurrence.
Summary:
- This study treated 9 children with secondary deformities following Wassel type IV thumb duplication correction.
- Surgical interventions included flexor tendon repositioning, A2 pulley reconstruction, joint capsule release, and thenar muscle reattachment.
- Fixation involved Kirschner wires followed by brace application for several months.
Impact:
- The described soft tissue reconstruction technique proved effective in managing secondary deformities.
- Post-operative bracing significantly contributes to preventing recurrent deformities.
- This approach offers improved functional and aesthetic outcomes for affected children.
Objective:
To investigate an effective therapeutic method for the secondary deformity after the correction of the Wassel type IV thumb duplication.
Methods:
9 cases of Wassel W-D Complex thumb deformities in children with postoperative secondary deformity, including 6 males and 3 female, were treated. The age ranged from 2.0 to 14 years old with an average of 5.3 years old. During the operation, the anatomical structure was dissected to observe the structure and alignment of the flexor tendon as well as anatomical structure of the joint. In the meantime, the flexor pollicis longus tendon was shifted, A2 pulley was reconstructed, joint capsule was released and contracted, the end point of thenar was shifted. Kirschner wires fixation were used for about 4-5 weeks, the brace fixation for about 3 months.
Results:
All the patients had radial side skin contracture of the interphalangeal joint, radial deviation of the thumb tip, radial side contracture and ulnar relaxation of the joint capsule. Flexor hallucis longus tendon was located in front of the radial side of the proximal phalanx, with no wrapped sheath or A2 pulley. Flexor hallucis longus tendon was attached to the thumb tip substrate, of which 1/3 was located in the center and 2/3 in the radial side. The thumb tip rotated about 10 degrees-15 degrees to the radial side. The patients were followed up for 6-38 months, with an average of 24 months. We adopted Tada standard to evaluate the follow-up results as excellent in 7 cases, good in 1 case, poor in 1 case.
Conclusions:
Soft tissue reconstruction for the secondary deformity after the correction of the Wassel type IV-D thumb duplication is an effective method. Application of the brace after removal of Kirschner wires has an important role in preventing the secondary deformity.