Salvage reconstruction of failed pollicization by distraction lengthening

Excerpt

Hypoplasia of the thumb can present as an isolated deformity or as part of a systemic process such as thrombocytopenia-absent-radius syndrome, Holt–Oram syndrome, Fanconi’s anemia, and VACTERL syndrome (vertebral abnormality, anal atresia, cardiac abnormality, tracheoesophageal fistula, esophageal atresia, renal abnormality, lower extremity abnormalities). If the hypoplastic thumb is not functional, pollicization of the index finger is the treatment of choice for Blauth type IIIB, IV (floating thumb), and obviously if the thumb is absent (type V). Successful pollicization of the index finger requires meticulous surgical technique, but good long-term results have been reported as high as 81% [23]. Functional limitations have been reported by many studies [1, 2, 5‐7, 10‐12, 16, 21, 22], but other reports of complications, including failures, are scarce. Reported complications include iatrogenic neurovascular injury, web space contracture, malrotation, functional deficits (decreased pinch and grip strength, lack of opposition), and stiffness [4]. …