• Archives of Plastic Surgery
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• v.38 no.6
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• pp.821-828
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• 2011

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.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.105-108
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• 2011

Purpose: An extensive knowledge of the arterial anatomy of the upper extremity and its variations is indispensable to the hand surgeon. We report a patient with anomalous radial artery, superficial course of two radial arteries, encountered during the excision of volar wrist ganglion. Methods: The patient was a 53-year-old man who had a painful mass on the left volar wrist for 1 year. Under general anesthesia, a curved incision was made around the mass. With the skin flaps retracted, the dome of the cyst was identified. Particular care was taken to identify and protect the radial artery, which was intimately attached to the wall of the ganglion. Two radial arteries completely encircled the ganglion. The pedicle was traced to the volar joint capsule, radiocarpal ligament. The joint was open and the capsular attachments were excised. Results: The patient made an uneventful recovery. There were two arterial pulsations at the volar side of the wrist joint. Compressing this site revealed that the major arterial contributor to blood supply in the hand was the ulnar artery. At angioCT, an anomaly of the radial artery was found with a duplication. The pathway of this aberrant artery was superficial to the original radial artery. It changed its course subcutaneously at the level of the tendon of the brachioradialis muscle, and crossing the wrist lateral to the original radial artery and ending in the deep palmar arch. Conclusion: Authors experienced a case of bifurcating radial artery encountered during the excision of ganglion on the volar of the wrist. Because these duplicated radial arteries make strong contributions to the thumb and index finger as well as to the deep palmar arch, when they are present there may be probably less blood supply to the hand from the ulnar artery. If the radial artery is palpated superficially on the brachioradialis muscle, it is important to remember the kind of anomaly.