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?
Signup and view all the answers
How do you classify thumb hypoplasia?
Signup and view all the answers
What is the Blauth classification?
Signup and view all the answers
What is the treatment for Blauth I?
Signup and view all the answers
What is the treatment for Blauth II?
Signup and view all the answers
What are your options for Thumb UCL reconstruction?
Signup and view all the answers
What is the treatment for Blauth IIIa?
Signup and view all the answers
What are the options for opponensplasty?
Signup and view all the answers
What is the treatment for Blauth IIIb?
Signup and view all the answers
What is the name for Blauth IV?
Signup and view all the answers
What is the treatment for Blauth IV?
Signup and view all the answers
What is the name for Blauth V?
Signup and view all the answers
What is the treatment for Blauth V?
Signup and view all the answers
What are the steps in Huber Transfer?
Signup and view all the answers
Describe the steps for Buck Gramcko pollicization.
Signup and view all the answers
What do the following structures become in Buck Gramcko Pollicization: EDC, EIP, 1st DI, 1st PI?
Signup and view all the answers
What is the classification for thumb duplication?
Signup and view all the answers
What is the Wassel classification?
Signup and view all the answers
How do you classify acquired thumb defects?
Signup and view all the answers
What is the treatment for distal 1/3 thumb amputation?
Signup and view all the answers
What is the treatment for distal middle 1/3 thumb amputation?
Signup and view all the answers
What is the treatment for proximal middle 1/3 thumb amputation?
Signup and view all the answers
What is the treatment for proximal 1/3 thumb amputation?
Signup and view all the answers
What are the advantages and disadvantages of index pollicization?
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?
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
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.