Reconstruction of Wassel–Flatt type IV–VII radial polydactyly with a modified Bilhaut–Cloquet procedure: a consecutive series of 22 cases

Abstract

Introduction:

Radial polydactyly reconstruction requires procedures that achieve both functional and aesthetic outcomes. When both duplicates are of similarly small diameters, a combination procedure may be necessary. Furthermore, primary surgical alignment is crucial to ensure a straight thumb and avoid future deviations. This study evaluates the modified Bilhaut–Cloquet procedure for the reconstruction of Wassel–Flatt types IV–VII radial polydactyly in paediatric patients.

Method:

The study included 22 patients aged 6–60 months. Inclusion criteria include similar-sized duplicated thumbs that meet nail criteria (<70% of a normal contralateral thumb), necessitating a combination procedure in order to create a functional and aesthetically pleasing single thumb. Patients were followed for an average of 14.5 months. Outcomes were assessed using a visual analogue scale for satisfaction (0–10), nail width and girth measurements, and the Tada scoring system for function and cosmesis.

Results:

All the flaps survived. The reconstructed thumbs had near-normal size, contour, and alignment. Five cases showed mild nail ridges without any severe deformities. The average nail width and girth were 97 and 96% of the values for the contralateral thumb, respectively. The mean visual analogue scale score was 8.9, indicating high patient satisfaction. The median Tada score was 4.7, with 15 excellent and seven good cases.

Conclusion:

In Wassel–Flatt type IV–VII radial polydactyly with both duplicates exhibiting smaller nail diameters, a combination technique using the modified Bilhaut–Cloquet procedure results in good appearance and function. Meticulous attention to detail can reduce the risk of complications, including nail deformities and flap loss.

Level of evidence:

IV