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"On-Top Plasty" for Radial Polydactyly Reconstruction.
Bryce Bell1, Lesley Butler1, Janith Mills1
1Charles E. Seay, Jr. Hand Center, Texas Scottish Rite Hospital for Children, Dallas, TX.
The Journal of Hand Surgery
|July 4, 2017
Summary
The on-top plasty technique offers reliable, long-term reconstruction for radial polydactyly when thumbs lack adequate structures. This method provides durable functional and aesthetic outcomes for complex cases.
Area of Science:
- Hand surgery
- Pediatric orthopedics
- Congenital hand anomalies
Background:
- Radial polydactyly presents challenges in thumb reconstruction.
- The "on-top plasty" technique addresses cases where neither thumb has sufficient proximal or distal components.
- This study evaluates the long-term efficacy of this specific reconstructive approach.
Purpose of the Study:
- To introduce the "on-top plasty" technique for radial polydactyly.
- To report the long-term outcomes of this surgical method.
- To assess functional and aesthetic results in a pediatric cohort.
Main Methods:
- Retrospective evaluation of 5 patients (5 thumbs) undergoing "on-top plasty" between 1998-2003.
- Inclusion of Flatt type III and VII thumbs, with an average age of 1.4 years at surgery.
- Assessment using subjective, objective, and patient-oriented outcome measures.
Main Results:
- All thumbs achieved union without soft tissue loss or requiring further surgery.
- Functional outcomes included mean metacarpophalangeal joint arc of 60° and interphalangeal joint arc of 19°.
- Pinch strength averaged 47% of age-matched norms, grip strength 54.2%, with high PedsQL scores and low DASH scores.
Conclusions:
- The "on-top plasty" is a reliable reconstruction method for radial polydactyly with inadequate thumb components.
- The technique yields durable results with over 10 years of follow-up.
- This approach provides a viable solution for complex congenital thumb anomalies.
