Boot-shaped Neurovascular Island Flap for Reconstruction of Radial Polydactyly

Abstract

Hypothesis: Reconstruction of radial polydactyly with a boot-shaped neurovascular island flap can result in good outcomes. Materials and Methods: A number of techniques are used for reconstruction of radial polydactyly, with the aim of reconstruction to obtain a stable, mobile thumb of adequate size and shape. Techniques include preserving the ulnar (or radial) thumb, reconstructing a contour defect with a boot-shaped neurovascular island flap and the Bilhaut-Cloquet procedure. A persistent problem is the asymmetry between the reconstructed and normal contralateral thumb. Between 2013 and 2015, 9 thumbs in 8 patients had reconstruction with a boot-shaped neurovascular island flap. The study group included 1 Wassel type I, 6 Wassel type IV, and 2 Wassel type VII. A boot-shaped neurovascular island flap was dissected out from the thumb to be removed. Specific modifications include the use of Bruner incisions dorsally and volarly to reduce scarring at the interphalangeal joint and also complete mobilization of the island flap on its pedicle to allow easier inset. A flexor pollicis longus and extensor tendon rebalancing technique was used to correct deviation of the reconstructed thumb’s interphalangeal (IP) joint in the Wassel type IV thumb duplication. Results: All boot-shaped neurovascular island flaps survived with good contour and shape, and obtained symmetry eponychial fold compared with the contralateral thumb. Reconstruction of radial polydactyly with a boot-shaped island neurovascular flap allows for good symmetry in shape and size following reconstruction, especially where 2 digits are equal or almost equal in size. Summary Points: A boot-shaped neurovascular island flap can be used for reconstruction of radial polydactyly with good outcomes.