gms | German Medical Science

Objectives/Interrogation: To report our volar approach of "on-top plasty" technique in reconstruction of radial polydactyly.

Methods: We evaluated 20 thumbs in 20 patients who underwent radial polydactyly reconstruction using the "on-top plasty" technique between 2009 and 2016. This technique was used when neither thumb possessed adequate proximal and distal structures to provide a functional and aesthetic thumb. The average age at time of surgery was 1.2 years and the mean follow-up time was 4.5 years. Subjective patient evaluation, objective outcomes values, and validated patient-oriented outcome measures were obtained.

Results and Conclusions: There was no soft tissue loss and union was achieved in all thumbs. Mean flexion-extension arc for the metacarpophalangeal joint was 62 degrees (range, 5 degrees extension to 72 degrees flexion) and at the interphalangeal joint was 18 degrees (range, 20 degrees extension to 30 degrees flexion). Mean percentage of age-matched norms for lateral, tripod, and tip pinch were 51%, 45%, and 49%, respectively. Mean grip strength was 56% of age-matched norm. The mean Pediatric Quality of Life Inventory (PedsQL) score for parent questionnaires was 92 and for teen/child questionnaires was 85. In conclusion, for patients with radial polydactyly in which neither thumb possesses adequate distal and proximal components, volar approach of "on-top plasty" is a reliable method which can reconstruct nice web and relatively lengthen the digit.