Lister G
Clin Orthop Relat Res. 1985 May(195):52-65.
Blauth has classified congenital hypoplasia of the thumb into five grades. Grade I requires no treatment. Grade II can be reconstructed by widening the first web space with various flaps, stabilizing the metacarpophalangeal joint, and performing an opponensplasty. In such cases, a pollex abductus configuration of the flexor pollicis longus should be sought, and if found, corrected. Grades III, IV, and V require pollicization, a procedure that has become more sophisticated by attention to skin flap design, intrinsic transfer, and positioning of the head of the second metacarpal. Partial aplasia should be treated by phalangization, distraction lengthening with free toe phalanx transfer, on-top plasty, or toe-to-hand transfer. The last is made more complex by the anomalous anatomy frequently present in aplasia. Reconstruction of the infant thumb should be complete before the first birthday.
布劳思将先天性拇指发育不全分为五个等级。一级无需治疗。二级可通过使用各种皮瓣扩大第一掌骨间隙、稳定掌指关节并进行对掌肌成形术来重建。在这种情况下，应寻找拇长屈肌的拇外展构型，若发现则予以纠正。三级、四级和五级需要进行拇指再造术，该手术通过关注皮瓣设计、内在肌转移以及第二掌骨头的定位而变得更加精细。部分发育不全应通过指骨形成术、游离趾骨转移牵引延长术、覆盖成形术或趾到手转移术来治疗。由于发育不全中经常存在的异常解剖结构，最后一种手术变得更加复杂。婴儿拇指的重建应在一岁生日前完成。
