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[Soft tissue balance technique by flexor pollicis longus tendon transfer for Wassel Ⅳ-D thumb duplication in
Hongjun Ren1, Yong Yang2, Wenyao Zhong2
1Department of Hand Surgery, Beijing Shuili Hospital, Beijing, 100036, P. R. China.
Insights
This study shows that using the flexor pollicis longus (FPL) tendon transfer for Wassel IV-D thumb duplication effectively corrects alignment in children. Long-term effectiveness requires further investigation.
Area of Science:
- Hand surgery
- Pediatric orthopedics
- Congenital hand differences
Background:
- Wassel IV-D thumb duplication is a complex congenital hand anomaly.
- Surgical correction aims to restore function and aesthetics.
- Soft tissue balance is crucial for optimal outcomes.
Purpose of the Study:
- To evaluate the effectiveness of flexor pollicis longus (FPL) tendon transfer for soft tissue balance in Wassel IV-D thumb duplication.
- To assess functional and aesthetic outcomes in pediatric patients.
Main Methods:
- Retrospective analysis of 14 children with Wassel IV-D thumb duplication.
- Surgical technique involved excising the radial thumb and utilizing its FPL tendon for ulnar thumb soft tissue reconstruction.
- Postoperative evaluation included range of motion (ROM), joint alignment, nail plate width, and thumb circumference.
Main Results:
- Significant improvement in passive interphalangeal joint (IP) flexion and metacarpophalangeal joint (MCP) deviation post-surgery.
- No significant improvement in passive IP extension or passive MCP flexion.
- MCP passive extension remained 0° both pre- and post-operatively.
- Nail plate width averaged 76.6% and thumb circumference 92.0% of the unaffected side.
Conclusions:
- FPL tendon transfer is an effective technique for correcting alignment in Wassel IV-D thumb duplication.
- The technique demonstrates sustained correction effects.
- Further long-term follow-up and comprehensive evaluation are necessary to confirm enduring effectiveness.
Objective:
To investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children.
Methods:
A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb.
Results:
All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side.
Conclusion:
The soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.
