Kim Byung Jun, Choi Jun Ho, Kwon Sung Tack
Seoul and Seongnam, Republic of Korea.
From the Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine; and the Department of Plastic and Reconstructive Surgery, Armed Forces Capital Hospital.
Plast Reconstr Surg. 2017 Dec;140(6):1220-1228. doi: 10.1097/PRS.0000000000003877.
Surgical treatment of Wassel type IV thumb polydactyly is technically challenging, especially when it has a zigzag deformity. However, the authors obtained good operative results by performing oblique osteotomy with autologous fat graft in 30 patients.
After removal of the extra digit, the radially deviated distal phalanx was corrected by performing oblique osteotomy at the proximal phalanx. Free fat tissue was grafted to the areas with soft-tissue deficiency. Surgical outcomes were evaluated in terms of the thumb length ratio compared to the normal counterpart, the angulation between the proximal phalanx and the distal phalanx, and the Tada score. As a negative control, the data of 46 type IV polydactyly patients without a significant axis deviation were evaluated.
The thumb length ratio was maintained from 0.96 ± 0.06 preoperatively to 1.01 ± 0.07 4-year postoperatively. The angulation improved from 30.84 ± 14.78 degrees to 11.03 ± 7.67 degrees. In comparison, the length ratio and angulation of the control group changed from 0.97 ± 0.04 to 0.98 ± 0.02, and from 19.46 ± 8.27 degrees to 14.10 ± 6.61 degrees, respectively. The Tada scores were 5.3 ± 0.88 in the oblique osteotomy group and 6.59 ± 0.62 in the control group, both of which were graded as good.
Oblique osteotomy with autologous fat graft is a good surgical option for treating the Wassel type IV polydactyly with zigzag deformity. This technique allows sufficient axis correction without bone shortening, and it provides adequate soft-tissue contouring.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
瓦塞尔IV型拇指多指畸形的手术治疗在技术上具有挑战性，尤其是当它存在锯齿状畸形时。然而，作者通过对30例患者进行斜行截骨术并自体脂肪移植获得了良好的手术效果。
切除多余手指后，通过在近节指骨进行斜行截骨术来纠正向桡侧偏斜的远节指骨。将游离脂肪组织移植到软组织缺损区域。根据与正常对侧相比的拇指长度比、近节指骨与远节指骨之间的成角以及多田评分来评估手术效果。作为阴性对照，评估了46例无明显轴偏差的IV型多指畸形患者的数据。
拇指长度比从术前的0.96±0.06维持到术后4年的1.01±0.07。成角从30.84±14.78度改善到11.03±7.67度。相比之下，对照组的长度比和成角分别从0.97±0.04变为0.98±0.02，从19.46±8.27度变为14.10±6.61度。斜行截骨术组的多田评分为5.3±0.88，对照组为6.59±0.62，两者均评为良好。
斜行截骨术并自体脂肪移植是治疗伴有锯齿状畸形的瓦塞尔IV型多指畸形的良好手术选择。该技术可在不缩短骨骼的情况下进行充分的轴矫正，并提供足够的软组织塑形。
临床问题/证据水平：治疗性，III级。
