Article
Modified dorsal rotational advancement flap for reconstruction of congenital spade hand combined with one-stage opponensplasty
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Authors
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Xiaofang Shen
- Wuxi N0.9 People Hospital, Wuxi, China
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: To introduce surgical treatment techniques of congenital spade hand, and focus on the modified dorsal rotational advancement flap to reconstruct the thum web space and one-stage osteotomy transposition of radial finger so as to reconstruct thumb opponensplast.
Methods: Between Jan 2015 to April 2017, using modified dorsal rotational advancement flap, totally six children undergoing congenital spade hand reconstructed thum web space. With 90°rotation, one-stage radial finger osteotomy was used to reconstruct the opponensplast and the alignment was maintained by Kirschner wires. Besides, skin graft repair was used to dorsal thumb and radial side of index finger. Four weeks later, the K-wires were removed and rehabilitation was started. Postoperatively, clinical results were evaluated.
Results: The male-to-female ratio in the 6 patients was 1:1, and the median age was 15.5 months (range, 13-20). 4 of them had spade hand deformity in the left, while 2 in the right, and the patients were followed up for at least 12 months after surgery (range, 12-20). No distinct difference in the skin color between thumb web space and the healthy side was observed in all patients at the final follow-up, the thumb web distance in the affected hands ranged from 3.5cm to 5cm (average, 4.2cm), the depth and dilation extent of thumb web were close to those in the healthy side, and favorable functional recovery was achieved in the thumb opponensplast. 2 affected children had mild scar hyperplasia in the lateral incision, which was mitigated 6 months after wearing the pressure gloves, and no other complication was observed.
Conclusions: Modified dorsal rotational advancement flap combined with one-stage metacarpal osteotomy is an alternative surgical method for treating congenital spade hand deformity. One-stage thumb opponensplast reconstruction is conducive to the early use of the thumb to learning and exercising. In the meanwhile, one-stage surgery dissects neurovascular bundle, which can avoid the separation within scars and reduce surgical risk compared with the two-stage transposition thumb.
