18 - Complications in Surgery of the Thumb

Abstract

Pediatric thumb surgery aims to restore or recreate function of the thumb. Common pediatric thumb surgical procedures include pediatric trigger thumb release, hypoplastic thumb reconstruction, pollicization, and preaxial polydactyly reconstruction. Each of these surgeries poses unique challenges, and each has known complications. Careful preoperative planning, surgical technique, and postoperative care is necessary to minimize risks. Trigger thumb release divides the A1 pulley, and potential complications include digital nerve injury, inadequate pulley release, and wound complications. Surgical management of thumb hypoplasia depends on the degree of hypoplasia, with reconstruction for Blauth type II and IIIA hypoplasia and pollicization for types IIIB, IV, and V. Potential complications of hypoplastic thumb reconstruction include inadequate first web space release, scar contracture, metacarpophalangeal joint instability, tendon transfer failure, and stiffness. Pollicization is performed for congenitally absent or nonfunctional thumbs, and the preoperative function of the index finger determines the postoperative function of the pollicized digit. Early postoperative complications of pollicization include arterial insufficiency, venous congestion, marginal skin necrosis, and infection. Late complications include scar contracture, tendon adhesions, stiffness, angular deformity, and instability of the carpometacarpal joint. Preaxial polydactyly typically includes excision of the smaller thumb and stabilization/realignment of the larger thumb but may also include the Billhaut procedure and on-top plasty. The Billhaut procedure has largely fallen out of favor due to resulting nail deformity, joint stiffness, and growth arrest. Common postoperative complications of thumb polydactyly reconstruction include stiffness, joint instability, residual angulation, first web space contracture, and nail deformity.