We report the application and results of skin defect coverage using the free lateral great toe flap in revision surgery for residual postoperative deformities in Wassel-Flatt type IV-D thumb duplications. This retrospective study included five patients treated between June 2020 and September 2021 to correct angular deformity and repair the secondary skin defect. All the flaps survived. The patients were followed up for 8–12 months and all the reconstructed thumbs had a satisfactory appearance. The results of the Japanese Society for Surgery of the Hand scoring system were excellent in one patient, good in three patients and fair in one patient. The results of the Alignment, Ulnar and Radial stability, Range of motion and Aesthetical aspects (ALURRA) scoring system were good in four patients and moderate in one patient.
Cabrera GonzálezMPérez LópezLMMartínez SotoGGutiérrez de la IglesiaD.Prognostic value of age and Wassel classification in the reconstruction of thumb duplication. J Child Orthop. 2013,
7: 551–7.
6.
CooneyWPWolfJHoltkampKDobynsJH.Congenital duplication of the thumb. Handchir Mikrochir Plast Chir. 2004,
36: 126–36.
EzakiM.Radial polydactyly. Hand Clin. 1990,
6: 577–88.
9.
FoucherGSammutDCitronN.Free vascularized toe-joint transfer in hand reconstruction: a series of 25 patients. J Reconstr Microsurg. 1990,
6: 201–7.
10.
GholsonJJShahASBuckwalterJABuckwalterJA.Long-term clinical and radiographic follow-up of preaxial polydactyly reconstruction. J Hand Surg Am. 2019,
44: 244.e1–e6.
11.
GoldfarbCAPattersonJMMaenderAManskePR.Thumb size and appearance following reconstruction of radial polydactyly. J Hand Surg Am. 2008,
33: 1348–53.
12.
GuJXPanJBLiuHJ, et al.
Aesthetic and sensory reconstruction of finger pulp defects using free toe flaps. Aesthetic Plast Surg. 2014,
38: 156–63.
13.
HeBNanG.Causes of secondary deformity after surgery to correct Wassel type IV-D thumb duplication. J Hand Surg Eur. 2016,
41: 739–44.
14.
HoriiEHattoriTKohSMajimaM.Reconstruction for Wassel type III radial polydactyly with two digits equal in size. J Hand Surg Am. 2009,
34: 1802–7.
15.
HungLChengJCBundocRLeungP.Thumb duplication at the metacarpophalangeal joint. Management and a new classification. Clin Orthop Relat Res. 1996,
323: 31–41.
16.
KawabataHTadaKMasadaKKawaiHOnoK.Revision of residual deformities after operations for duplication of the thumb. J Bone Joint Surg Am. 1990,
72: 988–98.
17.
KayalarMGürbüzYKüçükLSügünTSAdemoğluYOzaksarK.Surgical reconstruction in Wassel type IV thumb duplication. Acta Orthop Traumatol Turc. 2014;
48: 181–6.
18.
LeeDCKimJSKiSHRohSYYangJWChungKC.Partial second toe pulp free flap for fingertip reconstruction. Plast Reconstr Surg. 2008,
121: 899–907.
19.
LuangjarmekornPVirojanawatNPongpacharaamphonPKitidumrongsookP.Preoperative angulation as a predictor for operations of Wassel type IV polydactyly. J Pediatr Orthop B. 2021,
30: 605–10.
20.
MihAD.Complications of duplicate thumb reconstruction. Hand Clin. 1998.
14: 143–9.
21.
MiuraT.An appropriate treatment for postoperative Z-formed deformity of the duplicated thumb. J Hand Surg Am. 1977,
2: 380–6.
22.
NaasanAPageRE.Duplication of the thumb. A 20-year retrospective review. J Hand Surg Br. 1994,
19: 355–60.
23.
OginoTIshiiSMinamiM.Radially deviated type of thumb polydactyly. J Hand Surg Br. 1988,
13: 315–9.
24.
PatelAUTonkinMASmithBJAlshehriAHLawsonRD.Factors affecting surgical results of Wassel type IV thumb duplications. J Hand Surg Eur. 2014,
39: 934–43.
25.
RehimSAChungKC.Local flaps of the hand. Hand Clin. 2014,
30: 137–51.
26.
RussoADeliaGCasoliVColonnaMRStagno d’AlcontresF.Dorsalis Pedis Adipofascial Perforator flap for great toe reconstruction: anatomical study and clinical applications. J Plast Reconstr Aesthet Surg. 2014,
67: 550–4.
27.
SohnWIJungSNKimSWKwonHImKS.Reconstruction of fingertip defects with great toe pulp grafts. Ann Plast Surg. 2012,
68: 579–82.
28.
TadaKYonenobuKTsuyuguchiYKawaiHEgawaT.Duplication of the thumb. A retrospective review of two hundred and thirty-seven cases. J Bone Joint Surg Am. 1983,
65: 584–98.
29.
TienYCChihTTWangTLFuYCChenJC.Soft tissue reconstruction for type IV-D duplicated thumb: a new surgical technique. J Pediatr Orthop. 2007,
27: 462–6.
30.
Van WyheRDTrostJGKoshyJCPedersonWC.The duplicated thumb: a review. Semin Plast Surg. 2016,
30: 181–8.
31.
WangYZhangQGuJYuanCLiuH.Comparison of treatment methods of thumb-tip defects with phalangeal bone exposure: modified heterodigital neurovascular island flap versus free lateral great toe flap. J Hand Surg Am. 2023. Doi: 10.1016/j.jhsa.2022.12.007.
32.
WasselHD.The results of surgery for polydactyly of the thumb. A review. Clin Orthop Relat Res. 1969,
64: 175–93.
33.
XuYLShenKYChenJWangZG.Flexor pollicis longus rebalancing: a modified technique for Wassel IV-D thumb duplication. J Hand Surg Am. 2014,
39: 75–82.e1.
34.
YanHOuyangYChiZGaoWZhangFFanC.Digital pulp reconstruction with free neurovascular toe flaps. Aesthetic Plast Surg. 2012,
36: 1186–93.
35.
YaoYZhouHLiLNanG.Epidemiological statistics of congenital thumb duplication in the Chinese population. J Orthop Surg Res. 2021,
16: 481.
36.
YuanCLiuHZhangHWangTGuJ.Reconstruction of thumb pulp defects using free lateral great toe flaps. J Hand Surg Am. 2021,
46: 421.e1–e7.
37.
ZhengHLiuJDaiXMachensHGSchillingAF.Free lateral great toe flap for the reconstruction of finger pulp defects. J Reconstr Microsurg. 2015,
31: 277–82.
