Advertisement

Intraoperative Observation of the Proper Digital Nerves in Wassel–Flatt Type Ⅳ Radial Polydactyly

Published:September 10, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.07.018

      Purpose

      The aim of the study was to present the intraoperative findings of the relevant digital nerves of the duplicated thumbs in an excision and reconstruction procedure for the Wassel–Flatt type Ⅳ radial polydactyly.

      Methods

      The study was conducted on patients with Wassel–Flatt type IV radial polydactyly who underwent excision and reconstruction between 2018 and 2021 at our institution. The ulnar digital nerve of the radial thumb and the radial digital nerve of the ulnar thumb were identified and traced intraoperatively. The level of the bifurcation of the nerves and abnormal findings were documented.

      Results

      A total of 123 hands in 119 patients were included in this study. In 114 hands, the bifurcation of the nerves was located within 1 cm of the metacarpophalangeal flexion crease. The radial digital nerve to the ulnar thumb was abnormally compressed in deep fascial tissue in 7 of these 114 hands. In 5 hands, the level of bifurcation was more than 1 cm proximal to the crease. No radial digital nerve to the ulnar thumb was identified in the remaining 4 hands.

      Conclusions

      Although rare, abnormal nerve compression of the digital nerve may exist in duplicated thumbs of Wassel–Flatt type IV radial polydactyly.

      Clinical relevance

      In an excision and reconstruction procedure, we suggest that the bifurcation of the nerves should be identified before the nerve to the radial thumb is excised to avoid injuring the nerve to the main ulnar thumb.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Van Wyhe R.D.
        • Trost J.G.
        • Koshy J.C.
        • Pederson W.C.
        The duplicated thumb: a review.
        Semin Plast Surg. 2016; 30: 181-188
        • Wang B.
        • Tian X.
        • Hu Y.
        Treatment of common congenital hand conditions.
        Clin Plast Surg. 2019; 46: 489-503
        • Wassel H.D.
        The results of surgery for polydactyly of the thumb. A review.
        Clin Orthop Relat Res. 1969; 64: 175-193
        • Cabrera Gonzalez M.
        • Perez Lopez L.M.
        • Martinez Soto G.
        • Gutierrez de la Iglesia D.
        Prognostic value of age and Wassel classification in the reconstruction of thumb duplication.
        J Child Orthop. 2013; 7: 551-557
        • Manske M.C.
        • Kennedy C.D.
        • Huang J.I.
        Classifications in brief: the Wassel Classification for radial polydactyly.
        Clin Orthop Relat Res. 2017; 475: 1740-1746
        • Yao Y.
        • Zhou H.
        • Li L.
        • Nan G.
        Epidemiological statistics of congenital thumb duplication in the Chinese population.
        J Orthop Surg Res. 2021; 16: 481
        • Miller R.
        • Kaempfen A.
        • Moledina J.
        • Sivakumar B.
        • Smith G.
        • Nikkhah D.
        Correction of thumb duplication: a systematic review of surgical techniques.
        J Hand Microsurg. 2020; 12: 74-84
        • Dijkman R.R.
        • van Nieuwenhoven C.A.
        • Hovius S.E.
        • Hulsemann W.
        Clinical presentation, surgical treatment, and outcome in radial polydactyly.
        Handchir Mikrochir Plast Chir. 2016; 48: 10-17
        • Kitayama Y.
        • Tsukada S.
        Patterns of arterial distribution in the duplicated thumb.
        Plast Reconstr Surg. 1983; 72: 535-542
        • Crowley B.
        • Stevenson S.
        • Diogo R.
        Radial polydactyly: putting together evolution, development and clinical anatomy.
        J Hand Surg Eur Vol. Jan. 2019; 44: 51-58
        • Saito S.
        • Tsuge I.
        • Yamanaka H.
        • Morimoto N.
        Soft tissue abnormalities in Wassel type VI radial polydactyly: a detailed anatomical study.
        J Hand Surg Eur. 2021; 46: 352-359
        • Marks T.W.
        • Bayne L.G.
        Polydactyly of the thumb: abnormal anatomy and treatment.
        J Hand Surg Am. Mar. 1978; 3: 107-116
        • He B.
        • Liu G.
        • Nan G.
        The anatomy of Wassel type IV-D thumb duplication.
        J Hand Surg Eur. 2017; 42: 516-522
        • Saito S.
        • Ueda M.
        • Murata M.
        • Suzuki S.
        Thenar dysplasia in radial polydactyly depends on the level of bifurcation.
        Plast Reconstr Surg. 2018; 141: 85e-90e
        • Bauer A.S.
        • Netto A.P.
        • James M.A.
        Thumb hypoplasia occurring in patients with preaxial polydactyly.
        J Hand Surg Am. 2020; 45: 182-188
        • Wu K.
        • Aibinder W.R.
        • Richards R.S.
        • Suh N.
        A new surface landmark for thumb digital nerve bifurcation: a cadaveric study.
        J Hand Surg Am. 2020; 45: 362 e1-362 e4
        • Jolley B.J.
        • Stern P.J.
        • Starling T.
        Patterns of median nerve sensory innervation to the thumb and index finger: an anatomic study.
        J Hand Surg Am. 1997; 22: 228-231