Unfortunately, there are patients who visit our hospital who have had their first surgery carried out by a surgeon with little experience in operating on congenital hand deformities or have no academic foundation of the condition, receive inadequate postoperative follow-up and are discharged, and subsequently present with worsening of their deformity.
In the first surgery, reconstruction must be carried out to regain the mechanical equilibrium of the thumb.
It is a surgery that should be performed by a hand surgeon who specialises in congenital hand deformities, and it should not be carried out by a plastic surgeon or an orthopedic surgeon who do not specialise in this.
Hand surgeons learn about the long-term course of the cases they are involved in and utilise it as feedback for their future surgeries.
Accumulating and analyzing data and sharing it with the world contributes to advances in medicine. During follow-up, examinations and imaging using X-ray are periodically carried out for evaluation. If any problems arise, interventions are suggested at the appropriate timings.
The first surgery and the postoperative follow-up are particularly important.
This also applies to other congenital hand and foot deformities.
There may be complications following surgery for polydactyly of the thumb. Complications include scars or contractures, deformity of the nail, reduction of range of movement, and deformity of the bone. Pulling of the scar tissue is known as a contracture. Limitation in the normal movement at a joint is known as reduced range of movement. A condition where the bone or joint is bent and cannot straighten is known as postoperative secondary deformity. If the secondary deformity worsens with the child’s growth, corrective surgery is carried out. Scarring, distorted shape of the digit and wound contractures are also indications for corrective surgeries.
We offer corrective surgery for patients even if the first surgery was carried out at a different hospital.
The ideal correction may not necessarily be achieved, depending on factors such as the location of the original scar, instability of the joint, presence of soft tissue adhesions, and wound contractures.
If the thumb is unable to straighten, it is known as secondary deformity. The central axis of the thumb is known as the alignmet, and in order to straighten the alignment, osteotomy, as well as centralization of the tendons, is necessary.
In the case pictured below, the patient received the first surgery at a different hospital at the age of 1 but visited our hospital as the thumb gradually began to bend. In the corrective surgery, we not only corrected the malalignment, but also revised the scar and step deformity on the radial side of the thumb, creating a natural shape.
In the Bilhaut procedure where the two thumbs are merged to create one thumb, there may be postoperative deformities such as ridged or narrowed deformity of the nail and widened and angulated shape of the thumb.
The Bilhaut procedure is an excellent technique that allows a thick stable thumb to be reconstructed from two hypoplastic thumbs with unstable joints. However, because the surgical procedure is complicated and the corrective surgery for potential postoperative deformities is even more complex than the first surgery, it should only be performed by a highly experienced specialist surgeon.
Below are images of the postoperative course of a patient who was referred to us for corrective surgery. The nails and pahanges were recombined, and correction of the narrowing and ridging of the nail and reduction of the thumb width, as well as correction of the alignment, were achieved. Depending on the degree of deformity, there may not be sufficient improvement from a single corrective surgery.