POLLICIZATION OF THE SECOND FINGER FOR A RADIAL

POLLICIZATION OF THE SECOND FINGER FOR A RADIAL HYPOPLASY 1 ALENA SCHMORANZOVA 1, 2, 3, RADEK KEBRLE 1, TOMAS HELLMUTH 1, STEPANKA DOCEKALOVA 2, EVA LEAMEROVA 3 HAND PLASTIC SURGERY INSTITUTE, VYSOKE NAD JIZEROU, CZ; 2 DEPARTMENT OF PLASTIC SURGERY, FACULTY OF MEDICINE, CHARLES UNIVERSITY IN HRADEC KRALOVE, CZ; 3 DEPARTMENT OF PLASTIC SURGERY, FACULTY OF MEDICINE, CHARLES UNIVERSITY IN PRAGUE, CZ Thumb hypoplasia Indication for pollicization • Group of congenital abnormalities of the thumb. • 3 B- unstable CMC (Manske, Mc. Caroll 1992) • Failure of formation, longitudinal, radial , 5 -8 weeks i. u. • 3 C – only a remnant metacarpal head (Buck. Gramcko) • Etiology not clear - radial longitudinal deficiencies occur in many conditions with a wide variety of etiologies, the causes for these malformations span the entire spectrum of genetic, environmental, teratogenic and other factors. • 4 - floating thumb Basic principles • Skin incision • 5 - absence • Neurovascular pedicle, preservation of intact nerve • Frequency: 1: 100 000 live births. • 50% both hands, more often right. • 80% of the defects are associated with other systematic anomalies. • A part of 30 syndromes / Holt Oram, Vacterl, TAR … / • Skeletal readjustment • Dg in case of simpler forms and early after birth may be difficult Since 2008 cohort of 29 children; 41 hands; 18 x man, 11 x woman; 12 x radial club hand • Preservation of the metacarpophalangeal joint and muscular stabilisation. • Results of the operations uniformly good. • A mobile index finger transferred to the thumb position will provide stability for grasp and mobility for pinch. • The ability to restore intrinsic muscle function is key procedure for a successful outcome. • Pollicization of index finger provides good functional and aesthetic result in patient with isolated thumb hypoplasia and is less reliable in patient with associated radial forearm deficiencies. Daniel (7), 5 years after operation knitting basket Adam (1), before Huber transfer to correct lack of oppozition