One stage thumb opponensplasty and polygonal flap in congenital spade hand reconstruction

Abstract

Objective To explore the clinical efficacy of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap in congenital spade hand reconstruction. Methods From January 2013 to March 2017, 8 cases of congenital spade hand were treated by metacarpal osteotomy, thumb opponensplasty and reconstruction of first web space by dorsal rectangle flap. The thumb web space and fingernail fold of thumb and index finger were reconstructed by rotation of polygonal flap. The dorsoulnar side of thumb and radial side of proximal segment of index finger were repaired by skin grafting. Results The thumb opposition and first web space of all the children achieved one-stage reconstruction. All the flaps and skin grafts survived. The average follow-up period was 16.1 months (range, 13 to 29 months). At the last follow-up, there was no significant difference in skin color between the first web space of the injured side and of the healthy side. The distance of the first web space ranged from 3.5 to 5.0 cm with an average of 4.2 cm. According to the modified Tada score, the results were rated as excellent in 7 cases and good in 1 case. Conclusion One-stage reconstruction of thumb opposition combined with polygonal skin flap for congenital spade hand deformity has improved hand function. The design of the flap is reasonable and can cover important areas effectively. The operation is safe and reliable for clinical application. Key words: Surgical flaps; Hand deformities,congenital; Spade hand; Microsurgery