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An alternative method to reconstruct grade-3 hypoplastic thumb by hemi-metacarpal transfer
Xiuyue Xu1, Yuzhou Liu1, Le Wang2
1Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai, People's Republic of China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China.
This study presents a novel two-stage surgical technique for grade-3 hypoplastic thumbs using the second metacarpal bone. The method successfully restored thumb function, enabling patients to perform daily activities with their reconstructed five-digit hand.
Area of Science:
- Orthopedic surgery
- Hand reconstruction
- Microsurgery
Background:
- Hypoplastic thumb, a congenital condition, presents significant functional deficits.
- Grade 3 hypoplastic thumbs require complex reconstructive strategies.
- Existing methods may involve donor site morbidity or complex vascular anastomoses.
Purpose of the Study:
- To introduce and evaluate a novel two-stage surgical technique for grade 3 hypoplastic thumb reconstruction.
- To assess the efficacy of using a hemi-longitudinal second metacarpal bone graft.
- To determine functional outcomes and patient satisfaction after the procedure.
Main Methods:
- A two-stage surgical approach was employed in seven patients.
- Stage 1: Hemi-longitudinal split of the second metacarpal for first metacarpal reconstruction.
- Stage 2: Opponensplasty using the flexor digitorum superficialis (FDS) tendon transfer.
Main Results:
- Complete bone union was achieved in all seven patients.
- All patients demonstrated the ability to oppose their thumb to the middle finger.
- Patients regained functional use for daily activities like writing, eating, and smartphone use.
Conclusions:
- This hemi-longitudinal second metacarpal bone reconstruction is an effective procedure for grade 3 hypoplastic thumbs.
- The technique preserves a functional five-digit hand without foot morbidity or need for vascular anastomosis.
- It offers a valuable option for improving hand function in complex congenital thumb anomalies.
