Search

Polydactyly is the most common congenital digital anomaly of the hand. Surgical treatment is rewarding. In this article, we describe the case of a 15-year-old male who was presenting thumb bilateral polydactyly. The diagnisis was clinic, completed by radiography which has objectified the anomaly type according to Wassel's classification. Operated in our hospital, he received a repair surgery at the level of his right hand by resection of supernumerary hypoplastic thumb, with restoration and anatomical reconstruction of the dominant thumb. He was discharged with no complications. The patient and his family were satisfied with the cosmetic and functional result. We discuss types of duplications, and principle of therapeutic approach of this pathology.

Recently the authors had the opportunity of performing surgery of a trifurcated thumb, an extremely rare morphological polydactylous condition of the thumb. Trifurcated thumb had not been included under classification of polydactylous thumb heretofore. Comments were made on this entity from the standpoint of its morphology and consideration was given to its developmental mechanism. Also as surgery was performed with the intention of creating one thumb out of three polydactylous components, discussion was made of the procedure employed.

The operation method for thumb polydactyly has developed from simple removal, and it has become the standard procedure at present to collect parts to be used from each of the components and reconstruct one thumb. Traditionally this has been accomplished by the bisecting and joining procedure, known as Bilhaut-Cloquet's method, for the distal phalangeal type, and by the extended bisecting and joining method for the proximal phalangeal type. However, these procedures are technically difficult, and the cosmetic and functional prognosis has not been so good. Undoubtedly, the cause of this is that hard tissue like phalanges and nails are joined together, and recently the tendency is strong to avoid joining such tyssues as much as possible. The authors have since 1981 performed plastic operation by a modified method of the traditional bisecting and joining method, in which we remove one of the components and use the removed digit as a fillet. As the result, it has been found that our method not only makes the traditional method wholly unnecessary for the distal phalangeal type but also gives far better results than the past method for the proximal phalangeal type. Nevertheless, there are still cases that have to be treated by the traditional bisecting and joining method, and where to set the point of tangency of the methods will be a problem to be resolved in future.

In duplication of the thumb there is sometimes radial deviation of one or both components. Eight such hands have been studied. The findings are described and treatment discussed.

Lifetime-standing psychosocial effects of congenital hand anomalies are inevitable in patients who have not received a comprehensive treatment with appropriate timing and approach. Herein, two adult cases of untreated thumb polydactyly are presented. Both of them had hands with striking appearance and late consequent psychosocial problems.