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On-top-plasty reconstruction for thumb triplication
Kosuke Kuwahara1,2, Sohachi Toriyabe3, Masahiro Nakagawa2
1Department of Plastic Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
JPRAS Open
|September 7, 2023
Summary
Thumb triplication, a rare radial polydactyly, presents complex surgical challenges. On-top-plasty successfully reconstructed a functional and aesthetic thumb in a pediatric case.
Area of Science:
- Hand surgery
- Congenital anomalies
- Pediatric orthopedics
Background:
- Thumb triplication is a rare congenital anomaly characterized by three distinct thumbs.
- Its complex morphology necessitates innovative surgical approaches beyond standard polydactyly treatments.
- Effective management aims to restore function and aesthetics in affected hands.
Observation:
- A 17-month-old boy presented with right hand thumb triplication.
- The condition involved a complex duplication requiring specialized surgical intervention.
- Standard surgical algorithms for polydactyly were insufficient due to the unique presentation.
Findings:
- On-top-plasty was performed, utilizing the ulnar thumb over the intermediate thumb.
- This technique maximized limited tissue, creating a thumb of adequate size.
- Interphalangeal optimization was achieved by incorporating the extra middle phalanx, and the first web space was secured.
Implications:
- On-top-plasty proved effective for thumb reconstruction in this complex case.
- The procedure offers a viable solution for maximizing tissue use in congenital hand anomalies.
- This case highlights the adaptability of on-top-plasty for functional and aesthetic thumb restoration.