Górecki Michał, Czarnecki Piotr, Romanowski Leszek
Department of Traumatology, Orthopedics and Hand Surgery, Poznan University of Medical Sciences, Poland.
Adv Clin Exp Med. 2025 Mar;34(3):385-392. doi: 10.17219/acem/186477.
A Blauth IIIB hypoplastic thumb is a significant functional and cosmetic problem for the developing hand in children. The gold standard in treatment is amputation and index pollicization. Despite the good functional results, some parents do not consent to the operation, mainly for cosmetic reasons.
The aim is to present a detailed description and features of the technique used in our department for stabilization of a hypoplastic thumb type Blauth IIIB with a non-vascularized proximal interphalangeal joint from the toe. This is the first description of this surgery for this kind of congenital defect, together with the largest group of patients analyzed compared to alternative techniques described in the literature.
Sixteen patients were included in the analysis. The mean age was 3 years (standard deviation (SD) ±2). In most cases, it was a unilateral and isolated defect. We described the surgical technique and postoperative management in detail and assessed intraoperative factors such as donor selection, operative time, technical problems, stabilization time, complication rate, and reoperations. Appropriate statistics were performed.
Most often, the graft was taken from the 3rd toe. The average operation time was 59 ±17.5 min. No technical problems were found during the surgery. The Kirschner wire was removed after an average of 6.5 weeks. The complication rate was 25%, which included the destabilization of Kirschner wires or graft non-union, but it decreased to 6% after reoperation. Five patients underwent tendon transfers.
The presented technique is based on principles such as vascularized metatarsophalangeal joint transplants. It may be an option for stabilizing a hypoplastic thumb if parents do not consent to pollicization. Having microsurgical skills is unnecessary. The operation and anesthesia times are significantly shorter, resulting in less burden on the child's body. The study will continue assessing long-term postoperative functions and the comparison to pollicization.
Blauth IIIB型发育不全拇指对于儿童发育中的手部而言是一个严重的功能和外观问题。治疗的金标准是截肢和示指拇化术。尽管功能效果良好，但一些家长因主要是外观原因而不同意手术。
旨在详细描述我们科室用于稳定Blauth IIIB型发育不全拇指的技术特点，该技术采用来自足部的非血管化近端指间关节。这是首次针对此类先天性缺陷的该手术的描述，并且与文献中描述的其他技术相比，分析的患者群体规模最大。
16例患者纳入分析。平均年龄为3岁（标准差±2）。多数情况下为单侧孤立性缺陷。我们详细描述了手术技术和术后管理，并评估了术中因素，如供体选择、手术时间、技术问题、固定时间、并发症发生率和再次手术情况。进行了适当的统计学分析。
最常取自第3趾。平均手术时间为59±17.5分钟。手术过程中未发现技术问题。平均6.5周后取出克氏针。并发症发生率为25%，包括克氏针松动或移植物不愈合，但再次手术后降至6%。5例患者接受了肌腱转移术。
所介绍的技术基于血管化跖趾关节移植等原则。如果家长不同意进行拇化术，该技术可能是稳定发育不全拇指的一种选择。无需显微外科技术。手术和麻醉时间明显更短，从而减轻了儿童身体的负担。该研究将继续评估术后长期功能以及与拇化术的比较。
