Purpose
To introduce the “on-top plasty” technique and report our long-term outcomes.
Methods
We evaluated 5 thumbs in 5 patients who underwent radial polydactyly reconstruction
using the “on-top plasty” technique between 1998 and 2003. This technique was used
when it was felt that neither thumb possessed adequate proximal and distal structures
to provide a functional and aesthetically pleasing thumb. Our study group included
1 Flatt type III and 4 Flatt type VII thumbs. The average age at time of surgery was
1.4 years and at final follow-up was 13.5 years. Subjective patient evaluation, objective
outcomes values, and validated patient-oriented outcome measures were obtained.
Results
There was no soft tissue loss and union was achieved in all thumbs with no further
surgery required in any thumb. Mean flexion-extension arc for the metacarpophalangeal
joint was 60° (range, 10° extension to 70° flexion) and at the interphalangeal joint
was 19° (range, 25° extension to 35° flexion). Mean percentage of age-matched norms
for lateral, tripod, and tip pinch were 47.0%, 45.9%, and 47.8%, respectively. Mean
grip strength was 54.2% of age-matched norm. The mean Pediatric Quality of Life Inventory
(PedsQL) score for parent questionnaires was 89.0 and for teen/child questionnaires
was 89.1. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire revealed
a mean score of 4.3.
Conclusions
For patients with radial polydactyly in which neither thumb possesses adequate distal
and proximal components, the on-top plasty is a reliable method of polydactyly reconstruction
with durable results at longer than 10 years’ follow-up.
Type of study/level of evidence
Therapeutic V.
Key words
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Article info
Publication history
Published online: June 29, 2017
Accepted:
May 24,
2017
Received:
January 20,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
