Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Extended Indications of Bilhaut-Cloquet Procedure for Type III and IV of Duplicated Thumb

무지 다지증 III, IV형의 치료에 Bilhaut-Cloquet 방법의 적극적 이용

  • Lim, Young-Bin (Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University) ;
  • Seul, Jung-Hyun (Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University) ;
  • Nam, Hyun-Jae (Kim & Woo's Institute for Hand & Reconstructive Microsurgery, W Hospital) ;
  • Woo, Sang-Hyun (Kim & Woo's Institute for Hand & Reconstructive Microsurgery, W Hospital)
  • 임영빈 (동국대학교 의과대학 성형외과학교실) ;
  • 설정현 (동국대학교 의과대학 성형외과학교실) ;
  • 남현재 (W(더블유)병원 '김앤우' 수부외과센터) ;
  • 우상현 (W(더블유)병원 '김앤우' 수부외과센터)
  • Received : 2011.07.26
  • Accepted : 2011.08.24
  • Published : 2011.11.10
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Abstract

Purpose: The authors applied Bilhaut-Cloquet procedure to Wassel type III and IV duplicated thumb, which was limited to patients with Wassel type I, II. This procedure was applied in order to improve the growth potential, range of joint motion, joint stability and cosmetic outcome. Methods: Sixteen patients received Bilhaut-Cloquet procedures to correct duplicated thumbs from May, 2005 to December, 2010. Seven patients were Wassel type III, nine patients were type IV. This procedure was applied not only to balanced type, but also unbalanced type or convergent type. Five patients were balanced type and eleven patients were unbalanced type. Convergent type of Wassel type IV was three. Sex ratio was the same, mean age at the operation was 20.1 months old (8~52 months old). Angular deformity, joint stability and range of joint motion and cosmetic outcome were considered together and estimated in Tada score. Also, postoperative subjective satisfaction score of the parents was evaluated by a 100-points scale. Results: Mean subjective satisfaction scored 75 points at 28 months after the operation. Radiologic study showed bony union of proximal phalangeal bone and stable joint in all patients. Range of motion was mean 20 degrees in interphalangeal joint and mean 73 degrees in metacarpophalangeal joint. Tada score showed 'good' in eleven patients (68.8%), 'fair' in three patients (18.7%) and 'poor' in two patients (12.5%). In seven patients those who were able to follow up for a long term showed no significant difference in length of proximal and distal phalangeal bones compared to the opposite thumb. Conclusion: Bilhaut-Cloquet procedure can be applied not only to balanced type of Wassel type III, IV duplicated thumb, but also to unbalanced type or convergent type that focused on functional reconstruction and cosmetic improvement.

Keywords

References

  1. Yen CH, Chan WL, Leung HB, Mak KH: Thumb polydactyly: clinical outcome after reconstruction. J Orthop Surg 14: 295, 2006 https://doi.org/10.1177/230949900601400312
  2. Yasuda M: Pathogenesis of preaxial polydactyly of the hand in human embryos. J Embryol Exp Morphol 33: 745, 1975
  3. Wassel HD: The results of surgery for polydactyly of the thumb. A review. Clin Orthop Relat Res 64: 175, 1969
  4. Upton J: Disorders of duplication. In Mathes SJ: Plastic surgery. 2nd ed, Philadelphia, Saunders, 2006. p 215
  5. Tonkin MA, Bulstrode NW: The Bilhaut-Cloquet procedure for Wassel types III, IV and VII thumb duplication. J Hand Surg Eur 32: 684, 2007 https://doi.org/10.1016/J.JHSE.2007.05.021
  6. Bilhaut: Guerison d'un pouce bifide par un nouveau procede operatoire. Congr Fr Chir 4:576, 1889 [Translated into English by Tonkin HE, Tonkin MA. Hand Surgery, 2: 75, 1997]
  7. Hartrampf CR, Vasconez LO, Mathes S: Construction of one good thumb from both parts of a congenitally bifid thumb. Plast Reconstr Surg 54: 148, 1974 https://doi.org/10.1097/00006534-197408000-00004
  8. Baek GH, Gong HS, Chung MS, Oh JH, Lee YH, Lee SK: Modified Bilhaut-Cloquet procedure for Wassel type-II and III polydactyly of the thumb. Surgical technique. J Bone Joint Surg Am 90: 74, 2008 https://doi.org/10.2106/JBJS.G.01104
  9. Horii E, Nakamura R, Sakuma M, Miura T: Duplicated thumb bifurcation at the metacarpophalangeal joint level: factors affecting surgical outcome. J Hand Surg Am 22: 671, 1997 https://doi.org/10.1016/S0363-5023(97)80127-X
  10. Tada K, Yonenobu K, Tsuyuguchi Y, Kawai H, Egawa T: Duplication of the thumb. A retrospective review of two hundred and thirty-seven cases. J Bone Joint Surg Am 65: 584, 1983 https://doi.org/10.2106/00004623-198365050-00002
  11. Park JK, Lee YK, Kim JY, Lee HH, Lee YJ, Woo SH: Current trends of reconstructive surgery for the 173 cases of Korean duplicated thumbs based on the Iowa system. J Korean Soc Hand Surg 14: 43, 2009
  12. Kozin SH: Deformities of the thumb. In Green DP(ed): Green's operative hand surgery. 5th ed, Philadelphia, Elsevier Churchill Livingstone, 2005, p 1445
  13. Woo SH, Seul JH: Distal thumb reconstruction with a great toe partial-nail preserving transfer technique. Plast Reconstr Surg 101: 114, 1998 https://doi.org/10.1097/00006534-199801000-00019