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A modified Bilhaut-Cloquet procedure for thumb duplication: Reconstruction of functionality and appearance
Bo He1, Guoxin Nan2
1Ministry 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, China; Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2 road 136#, Chongqing 400014, China.
Background:
The Bilhaut-Cloquet technique is the preferred surgical method for thumb polydactyly with symmetrical caliber and osseous components. However, the traditional Bilhaut-Cloquet technique has many esthetic and functional complications. In this study, we aimed to investigate an effective modified Bilhaut-Cloquet procedure for Wassel type IV thumb duplication.
Methods:
The dorsal scar of the thumb was hidden on the ulnar side of the thumb through the flap design. The nail bed was sutured flat by combining the phalangeal bone and nail bed on different planes. The sensory function of the thumb was restored by keeping the ulnar skin of the thumb intact.
Results:
Our modified Bilhaut-Cloquet procedure did not reduce the mobility of the joints. All patients had relatively rounded fingernails, and no seagull deformity was present. The ulnar side of the palm skin of the thumb remained intact with no scars, maximizing the preservation of the sensory function of the thumb. All the operated children and their parents were satisfied with the esthetic result.
Conclusions:
We hid the surgical scar by improving the surgical method and reducing the thumb seagull nail deformity, and the influencing of the finger sensation caused by the scar on the finger abdomen. The procedure improved not only the appearance of the reconstructed thumbs but also the sensory function of the thumbs.
