On Top Plasty surgery combined with antegrade digital artery island flap for the treatment of special Wassel Ⅵc type thumb duplication
Objective To investigate the effect of On-Top-Plasty technique in the proximal phalangeal plane osteotomy combined with antegrade digital artery island flap for the treatment of special Wassel Ⅵc type thumb duplication.Methods From January 2017 to December 2022,8 children with special Wassel Ⅵc type thumb duplication were treated.Clinical manifestations:the duplicated thumb has a separate metacarpal and phalangeal bone,and the radial finger has extension and flexion function,but the appearance of the finger body was poor,while the appearance of the ulnar finger was relatively good,but the radial fold was not fully developed,the finger body was relatively small,and the metacarpal bone was poorly developed.On-Top-Plasty surgery combined with anterograde digital artery island flap treatment were performed.Soft tissue reconstruction was performed using an anterograde digital artery island flap with nail fold on the radial thumb,which was spliced with the middle and distal segments of the ulnar finger,and the "composite finger" extensor flexor tendon was reconstructed.Bone tissue reconstruction involved removing the distal part of the proximal phalanx of the radial thumb,grafting the underdeveloped middle segment of the proximal phalanx of the ulnar finger onto the proximal phalanx of the radial finger,in order to reshape a relatively good looking and functional thumb.Results The surgery was successfully completed without any complications such as infection or flap necrosis.All patients were follow-up for a period of 11 to 32 months,with an average of 17.3 months.The ratio of reconstructed thumb circumference to the healthy thumb was 103％ to 115％,and there was no radial deviation of the finger during the last follow-up.According to the improved Tada score,with a score of 3 to 5 points,3 cases were excellent and 5 cases were good.Conclusion The use of On-Top-Plasty surgery with proximal phalangeal plane osteotomy combined with anterograde digital artery island flap for the treatment of special Wassel Ⅵ type thumb duplication is a scientific and effective method,which can effectively improve the appearance and function of the finger after surgery.It is an effective method for treating this type of special Wassel Ⅵ type thumb duplication.
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