Sunday, July 15, 2018

Extra Thumb Reconstruction

I have posted a number of times on radial polydactyly- aka split thumb, extra thumb, etc- HERE.  This is a common birth anomaly and the decision for surgery is usually straightforward.  Sometimes surgery is also straightforward while other times the reconstruction can be quite challenging.  And, about one out of three patients with radial polydactyly will need a second surgery at some point down the road.

I wanted to briefly share images of one patient who recently came back for repeat assessment after reconstruction for a somewhat complex radial polydactyly reconstruction.  Here is one picture before surgery in the clinic.  Note that the inner thumb is larger, clearly the dominant thumb.

Radial polydactyly

Here are other pictures before surgery from top and bottom.
Radial polydactyly from the palm view.

Radial polydactyly from top view

In surgery, we removed the outer, smaller thumb and realigned the remaining thumb with a cutting of the bone.  We also created a new ligament to support the thumb.  The metal pin is left in place for about 6 weeks with a cast.

The thumb after reconstruction for radial polydactyly.

Another view after reconstruction for radial polydactyly

Here is the patient/ thumb about 6 months after surgery.  He has fully incorporated the thumb into daily use. The thumb is stable and has reasonable motion.  Importantly, despite a very successful surgery for radial polydactyly, when we compare the thumbs, the smaller size of the new thumb is clear.  That is why some of us prefer the term 'split thumb' which emphasizes that even after surgery, the thumb will be smaller.  However, the thumbs will typically look great and unless directly compared as in the pictures, this size difference does not affect function and does not dramatically affect appearance.
Smaller thumb after radial polydactyly reconstruction.

Thumb after reconstruction for radial polydactyly

I typically follow patients for a few years after surgery to assure no early problems develop and, of course, welcome families to come back anytime if issues are noted.  Overall, reconstruction for radial polydactyly is usually a very successful surgery providing a highly functional thumb which works well and looks near normal.

Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu



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