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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Modified Bilhaut-Cloquet procedure: meticulous nail plasty, bone reconstruction and radial side incision

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  • presenting/speaker Weiyang Gao - The Second Affiliated Hospital of Wenzhou Medical University, Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China
  • Jian Ding - The Second Affiliated Hospital of Wenzhou Medical University, Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China
  • Anyuan Wang - The Second Affiliated Hospital of Wenzhou Medical University, Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China
  • Long Wang - The Second Affiliated Hospital of Wenzhou Medical University, Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1414

doi: 10.3205/19ifssh1166, urn:nbn:de:0183-19ifssh11667

Published: February 6, 2020

© 2020 Gao et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The complications of Bilhaut-Cloquet procedure, including nail deformity, joint stiffness and dramatic unaesthetic scar, were common. In this study, we analyzed the surgical results which were treated by Bilhaut-Cloquet procedure in our patients.

Methods: From January 2010 to April 2014, 39 thumbs of 36 cases acquired more than one year follow-up, including 21 boys and 15 girls (average age: 22.3 months). The right thumb was involved in 25 cases, left in 14 cases. All cases were hypoplastic and the nail width was less than index-finger or 80% of non-affected thumb. All thumbs were treated by our modified Bilhaut-Cloquet procedure: A modified nail fusion technique included nail lunula design, nail fold plasty, meticulous nail bed suture and nail plate replantation; Bone reconstruction remained intact interphalangeal (IP) joint and metacarpophalangeal (MP) joint; A new incision design retained an intact pulp. The results were evaluated by Tada scoring system and Wang-Gao scoring system.

Results and Conclusions: According to the Tada scoring system, excellent result were found in 30 thumbs, good in 8 and poor in 1. The total mobility of the IP and MP joint was more than 70° in 33 thumbs, 50-70° in 5 thumbs and less than 50° in 1 thumb. The axis deviation was less than 10° in 21 thumbs, 10-20° in 12 thumbs and more than 20° in 6 thumbs. The joint instability was found only in 3 thumbs. According to the Wang-Gao nail appearance scoring system, excellent results were in 32 thumbs, good in 7 thumbs. The nail width was 85% of the contralateral side in 37 thumbs. Smooth nail was found in 4 thumb, and ridge or gap was found in 35 thumb (mild: 33, severe: 2). The continuous curve of the lunula was found in 29 thumbs and lunula malposition was found in 10 thumbs (mild: 7, severe: 3). 28 thumbs had no nail fold malposition, and 11 thumbs had nail fold malposition (mild: 9, severe: 2). One nail was hypoplasia and one nail was dehiscence. 33 thumbs were satisfied by the patients or their parents, fair in 5, unsatisfactory in 1. The scar was hidden at the radial and distal side of the thumb, and the intact and plump pulp was found in all the cases.

The nail deformity is inevitable accroding to our technique, but the nail appearance and thumb function is satisfying. The modified Bilhaut-Cloquet procedure should be recommended as the first choice for duplicated thumbs in hypoplasia type.