Thumb Recon Flashcards

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Questions and Answers

What are the 7 goals of thumb reconstruction?

Sensation, Length, Mobility, Stability, Strength, Painless, Durable coverage.

What are the congenital causes of thumb deformities?

Failure of Formation, Failure of Differentiation, Undergrowth, Constriction Band Syndrome.

Which congenital thumb deformity is associated with autosomal dominant inheritance?

Tri-phalangeal thumb.

What is the associated syndrome VACTERL stand for?

Vertebral, Anal, Cardiac, TE fistula, Renal, Limb. Signup and view all the answers

How do you classify thumb hypoplasia?

Blauth classification. Signup and view all the answers

What is the Blauth classification?

I. Mild, II. Moderate, IIIa. Severe, IIIb. Severe + Absent CMC, IV. Pouce Floutant, V. Thumb Aplasia. Signup and view all the answers

What is the treatment for Blauth I?

Reassurance +/- Web space Release. Signup and view all the answers

What is the treatment for Blauth II?

Webspace Release + UCL Recon. Signup and view all the answers

What are your options for Thumb UCL reconstruction?

Plicate existing ligaments, Free tendon recon (palmaris, EDQ), Arthrodesis, Recon with tendon used for opponensplasty (ADM-Huber). Signup and view all the answers

What is the treatment for Blauth IIIa?

Webspace Release + UCL Recon + Opponensplasty. Signup and view all the answers

What are the options for opponensplasty?

Huber = AbDM Transfer, FDS 3 or 4. Signup and view all the answers

What is the treatment for Blauth IIIb?

Ablation + Pollicization. Signup and view all the answers

What is the name for Blauth IV?

Pouce Floutant. Signup and view all the answers

What is the treatment for Blauth IV?

Ablation + Pollicization. Signup and view all the answers

What is the name for Blauth V?

Thumb aplasia. Signup and view all the answers

What is the treatment for Blauth V?

Pollicization (Buck Gramcko Technique). Signup and view all the answers

What are the steps in Huber Transfer?

<ol> <li>Incision ulnar border of proximal phalanx curving over hypothenar to wrist crease. 2. Disinsert AbDM from proximal phalanx. 3. Isolate AbDM to pisiform origin. 4. Subcutaneous tunnel. 5. Anchor into AbPB insertion (radial proximal phalanx of thumb).</li> </ol> Signup and view all the answers

Describe the steps for Buck Gramcko pollicization.

<ol> <li>Shorten index metacarpal (d2 MCPJ becomes 1st CMC). 2. Dissect index as island flap on flexors/extensors and NV bundles. 3. Pronate finger 120 degrees, fix metacarpal in palmar direction.</li> </ol> Signup and view all the answers

What do the following structures become in Buck Gramcko Pollicization: EDC, EIP, 1st DI, 1st PI?

<ol> <li>AbPL, 2. EPL, 3. AbPB, 4. AdP.</li> </ol> Signup and view all the answers

What is the classification for thumb duplication?

Wassel classification. Signup and view all the answers

What is the Wassel classification?

I. Bifid distal phalanx, II. Duplicated distal phalanx, III. Bifid proximal phalanx, IV. Duplicated proximal phalanx (most common), V. Bifid MC, VI. Duplicated MC, VII. Triphalangeal Thumb. Signup and view all the answers

How do you classify acquired thumb defects?

By level. Signup and view all the answers

What is the treatment for distal 1/3 thumb amputation?

< 50% surface area = primary closure or secondary intention; > 50% surface area = 1st dorsal metacarpal artery flap. Signup and view all the answers

What is the treatment for distal middle 1/3 thumb amputation?

Webspace deepening (Z plasty, dorsal rotation flap). Signup and view all the answers

What is the treatment for proximal middle 1/3 thumb amputation?

<ol> <li>Metacarpal lengthening (distraction osteogenesis- can get 3cm) + webspace deepening; 2. Toe-Thumb Transfer.</li> </ol> Signup and view all the answers

What is the treatment for proximal 1/3 thumb amputation?

<ol> <li>Pollicization of index finger; 2. Toe to thumb transfer (great toe or 2nd toe).</li> </ol> Signup and view all the answers

What are the advantages and disadvantages of index pollicization?

Advantages: Single stage, near normal sensation, restores length, widens and deepens webspace; Disadvantages: Difficult to rehab adults, weak pinch, functional loss. Signup and view all the answers

What does each structure become in pollicization?

Signup and view all the answers

What is the NV supply for toe to thumb transfer?

<ol> <li>Dorsalis Pedis artery; 2. Deep Peroneal; 3. Superficial radial n. branch.</li> </ol> Signup and view all the answers

Study Notes

Goals of Thumb Reconstruction

Aim for sensation, length, mobility, stability, strength, painless function, and durable coverage.

Congenital Causes of Thumb Deformities

Includes failure of formation, failure of differentiation, undergrowth, and constriction band syndrome.

Tri-Phalangeal Thumb

This congenital thumb deformity is characterized by autosomal dominant inheritance.

Associated Syndromes: VACTERL

VACTERL syndrome includes vertebral, anal, cardiac, tracheoesophageal fistula, renal, and limb anomalies.

Classification of Thumb Hypoplasia

Classified using Blauth classification.

Blauth Classification Breakdown

I: Mild
II: Moderate
IIIa: Severe
IIIb: Severe with absent carpometacarpal (CMC)
IV: Pouce Floutant
V: Thumb aplasia

Treatment for Blauth Class I

Reassurance with possible web space release.

Treatment for Blauth Class II

Web space release combined with ulnar collateral ligament (UCL) reconstruction.

Options for Thumb UCL Reconstruction

Approaches include plicating existing ligaments, free tendon reconstruction (using palmaris longus or extensor digitorum quartus), arthrodesis, or using tendon for opponensplasty (ADM-Huber).

Treatment for Blauth Class IIIa

Requires web space release, UCL reconstruction, and opponensplasty.

Options for Opponensplasty

Huber transfer (Abductor Digiti Minimi transfer) or use of flexor digitorum superficialis (FDS) from digits 3 or 4.

Treatment for Blauth Class IIIb

Involves ablation and pollicization.

Blauth Class IV

Known as Pouce Floutant, treated similarly to IIIb with ablation and pollicization.

Treatment for Blauth Class V

Thumb aplasia, treated with pollicization using the Buck Gramcko technique.

Steps in Huber Transfer

Conduct incision along the ulnar border of the proximal phalanx, disinsert AbDM, isolate AbDM to its origin, create a subcutaneous tunnel, and anchor into the AbPB insertion on the radial proximal phalanx.

Steps for Buck Gramcko Pollicization

Shorten the index metacarpal; dissect index as an island flap including flexors/extensors and neurovascular bundles; position and fix the metacarpal in a palmar direction.

Structures Transformed in Buck Gramcko Pollicization

EDC becomes AbPL, EIP becomes EPL, 1st DI becomes AbPB, and 1st PI becomes AdP.

Classification for Thumb Duplication

Wassel classification categorizes thumb duplication.

Wassel Classification Breakdown

I: Bifid distal phalanx
II: Duplicated distal phalanx
III: Bifid proximal phalanx
IV: Duplicated proximal phalanx (most common)
V: Bifid metacarpal
VI: Duplicated metacarpal
VII: Triphalangeal thumb

Classification of Acquired Thumb Defects

Classified by the level of amputation or defect.

Treatment for Distal 1/3 Thumb Amputation

If surface area < 50%, can use primary closure or secondary intention; if > 50%, a first dorsal metacarpal artery flap is indicated.

Treatment for Distal Middle 1/3 Thumb Amputation

Requires web space deepening, potentially using Z-plasty or dorsal rotation flap.

Treatment for Proximal Middle 1/3 Thumb Amputation

Metacarpal lengthening via distraction osteogenesis can add up to 3 cm, alongside web space deepening; toe-to-thumb transfer is an option.

Treatment for Proximal 1/3 Thumb Amputation

Pollicization of the index finger or toe-to-thumb transfer (from the great toe or second toe).

Advantages and Disadvantages of Index Finger Pollicization

Advantages include single-stage procedure, near-normal sensation, restored length, and web space enhancement.
Disadvantages involve challenging rehabilitation for adults, weaker pinch strength, and potential functional loss.

Neurovascular Supply for Toe-to-Thumb Transfer

Supplied by the dorsalis pedis artery, branching into the deep peroneal nerve and superficial radial nerve.

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Description

Test your knowledge on thumb reconstruction goals and congenital causes with these flashcards. Each card covers essential concepts, including the principles of thumb function and common congenital deformities. Ideal for medical students and professionals in the field of hand surgery.

Thumb Recon Flashcards - UE 21

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