Al-Qattan Mohammad M, Kattan Abdullah E, Al-Lazzam Abdulmohsen, Gelidan Adnan G
Division of Plastic and Hand Surgery, King Saud University, Riyadh, Saudi Arabia.
Plast Reconstr Surg Glob Open. 2017 Dec 28;5(12):e1589. doi: 10.1097/GOX.0000000000001589. eCollection 2017 Dec.
A review of the English literature over the least 43 years revealed only a total of 53 cases of Wassel types III, IV, and VII treated by the Bilhaut-Cloquet (B-C) procedure. Furthermore, the detailed results and range of motion were only given in 2 series (a total of 9 cases).
Four cases of Wassel types III and IV thumb duplications with zigzag deformity were treated with a modified B-C procedure. The main modification was minimal central resections at the joints aiming for joint preservation to improve the postoperative range of motion of the new thumb.
The results showed an excellent overall functional score (Tada score of 5 of 5 in all cases). The mean range of motion at the metacarpophalangeal joint was excellent (60°), but the mean at the interphalangeal joint was only 20°. Cosmetically, all thumbs were "too wide" and a panel of 3 hand surgeons scored the cosmetic result (0-10 scoring system) between 5.7 and 6.7. No secondary procedures were done, and all parents were "very satisfied" despite the wide thumbs and split nails. This was attributed to the presence of an ugly preoperative zigzag appearance, and hence the comparative postoperative appearance was satisfactory.
The modified B-C procedure gives a satisfactory function, but the cosmetic outcome is suboptimal.
对过去至少43年的英文文献回顾显示，仅共有53例瓦塞尔III型、IV型和VII型拇指重复畸形采用比尔奥-克洛凯（B-C）手术进行治疗。此外，仅有2个系列（共9例）给出了详细结果和活动范围。
4例伴有锯齿状畸形的瓦塞尔III型和IV型拇指重复畸形采用改良B-C手术治疗。主要改良之处在于关节处进行最小限度的中央切除，旨在保留关节以改善新拇指术后的活动范围。
结果显示总体功能评分优异（所有病例塔达评分为5分中的5分）。掌指关节的平均活动范围良好（60°），但指间关节的平均活动范围仅为20°。在外观方面，所有拇指均“过宽”，由3名手外科医生组成的小组对外观结果（0-10评分系统）的评分在5.7至6.7之间。未进行二次手术，尽管拇指较宽且指甲裂开，但所有家长均“非常满意”。这归因于术前存在难看的锯齿状外观，因此术后相对外观令人满意。
改良B-C手术功能令人满意，但外观效果欠佳。
