We report the case of a 17-year-old girl who consulted our Service to achieve a functional aesthetic improvement of her thumb on her left hand.
He was born with a small, non-functioning thumb, joined to the rest of his hand through a small thin skin tube. During lactation, he had been treated at the Children's Hospital where only a small skin tube had been implanted.
When he comes to our consultation he presents a thumb distal at the level of the metaphalangeal joint of the index, with a first narrow opening, without motor capacity or flexion-expression of both edges, but with good positioning, but
The patient did not have thenar eminence and did not recover the first metatarsal; she also had no radial pulse, but her ulnar pulse was adequately palpable.
The compensatory functional part was performed with some difficulty using a lateral digit-digital clamp between the index and the middle.
Dilatation was requested showing hypoplasia and fusion of the phalanxic agenesis of the first metatarsal, rest of the contracture with radial bone and ulnar absence, as well as compensatory artery of the radius;
With this clinical examination a typical partially treated left floating thumb was diagnosed.
In his right dominant hand, the following abnormalities were found in the thumb: first narrow space, absence of flexion creases, absence of thenar eminence, impossibility to flex the narrow space, but there was good interphalangeal mobility.
The radiological study and color Doppler showed no bone or vascular anomalies.
With these findings we could classify the right thumb in group I of Blauth.
No other congenital body anomalies were detected.
Treatment and results
A fine thumb should be carefully attached to some general objectives that help it to function, such as achieving stability, opposition, sensitivity, giving it a suitable length, mobility as much as possible.
In the reconstruction of a floating thumb there are two basically opposite behaviors, which should be widely discussed with parents and patients if they are at an age of understanding.
From a practical point of view, it is about deciding between one of the following therapeutic attitudes:
Amputation and reconstruction:
The amputation of the floating thumb will lead to aplasia that will require reconstruction with microsurgical techniques such as pulgarization of the index that is performed with good results since 1964 (3,4), or the transfer of a good technical infrastructure does not involve
In theory, they are the techniques that produce the best aesthetic and functional results.
Conservation and stabilisation:
Three types of behavior are possible depending on the type of pathology according to the Blauth classification
Establishment of a goal-oriented approach to managing mental illness in mental health services
Once the diagnosis was made and the problems identified in our patient, the mother and the patient were asked about the surgical procedures previously presented, but definitely it was extremely difficult to convince the patient to amputate the surveyed thumb.
Due to the possibility of performing, for example, a transfer with bone flap of the distal third of the radius nourished by the upper perforating branch of the interosseous artery anterior to the retrograde flow (7), it was not viable due to the long term
In order not to change the surgical field, the ipsilateral olecranon bone graft was harvested; then, neo-occurrence was oriented and secured with a mini-plate, vestigial level and at the level of phalanx.
In order to keep this position stable and avoid future displacements, it was decided to transfer the aesthetic muscle from the mental area to the neo-metatarget, to fix or stabilize the thumb opposition, as well as to try to increase.
The surgery was performed with a regional block under tourniquet neu
There were no postoperative complications
The patient was referred to the Physiotherapy Service for the design of a functional orthosis and later for the beginning of functional reeducation.
Psychologically, the patient has responded positively since she has managed to give utility to her new thumb and it has improved in her aesthetic appearance, although it is not the aspect that her expectations, normal or not, made her want.
