Reconstruction for thumb duplication using Bilhaut-Clouquet method

Abstract

Objective: Thumb polydactyly is an uncommon Type of congenital malformation. For the surgical treatment of this deformity, which is rarely encountered in clinical practice, we used the Bilhaut-Cloquet technique. In this study, we planned to determine the problems likely to be encountered during the observation and evaluation of the patients treated using the Bilhaut-Cloqet technique due to preaxial polydactyly. Material and Methods: A total of six cases, who were surgically treated and followed for preaxial thumb duplication symptom, were studied at the Department of Orthopedics and Traumatology, Faculty of Medicine, Ondokuz Mayis University. Right thumb duplication was present in four cases and left thumb duplication in two cases. The average age of the cases treated was 16 (8-36) months The average follow-up period was 13 (8-22) months. The patients were evaluated according to Wassel's classification. Results: We observed only Wassel Type 4 anomaly in six cases. A slight Z deformity developed in two cases. We had difficulty closing the defect in two patients. In order not to risk the existing flap circulation, the areas that were left open through loose closing were left for secondary healing. Conclusion: In many cases of thumb duplication, excision of the extra digit only is an abandoned technique due to the high rate of residual deformities. Reconstructive surgery in the treatment of this congenital deformity yields better functional and aesthetic results. Although thumb duplication is not an urgent clinical situation, a single finger reconstruction must be performed until the age one. The best period for this surgery is reported to be at 6-9 months. Although the results in Wassel Type 3 and 4 do not show any significant differences compared to Types 5 and 6, they are poorer than in Types 1 and 2. The most common complication in Type 3 and Type 4 is the Z deformity, occurring with the radial bending of distal phalanges and ulnar bending of proximal phalanx. If the sizes of both components are different, then it is necessary to make a flap design on the finger on the radial side. We suggest to form a larger flap for the excised digit on the radial side than the estimated defect to avoid a problem of inadequate flap size particularly for the initial patients.